Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study

Thomas, Lucy C., Rivett, Darren A., Attia, John R. and Levi, Christopher R. (2012) Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study. BMC Musculoskeletal Disorders, 13 Article 164: 503-511. doi:10.1186/1471-2474-13-164

Author Thomas, Lucy C.
Rivett, Darren A.
Attia, John R.
Levi, Christopher R.
Title Risk factors and clinical presentation of craniocervical arterial dissection: A prospective study
Journal name BMC Musculoskeletal Disorders   Check publisher's open access policy
ISSN 1471-2474
Publication date 2012-01-01
Year available 2012
Sub-type Article (original research)
DOI 10.1186/1471-2474-13-164
Open Access Status DOI
Volume 13
Issue Article 164
Start page 503
End page 511
Total pages 6
Place of publication London, United Kingdom
Publisher BioMed Central Ltd.
Language eng
Subject 2732 Orthopedics and Sports Medicine
2745 Rheumatology
Abstract Background: Craniocervical arterial dissection is a major cause of ischaemic stroke in young adults. The pathogenesis is not fully understood but is thought to be related to a combination of an intrinsic weakness in the arterial wall and an external trigger. Intrinsic susceptibility is thought to be a generalised arteriopathy, vascular anomaly or genetic predisposition. Proposed extrinsic factors include recent viral infection and minor mechanical trauma to the neck, including neck manipulation, which has raised concerns amongst manual practitioners in particular as to the appropriate screening of patients and avoidance of more vigorous therapeutic techniques. The presenting features of dissection may mimic a musculoskeletal presentation, creating a diagnostic dilemma for primary care practitioners. Early recognition is critical so that appropriate management can be commenced. The aims of this study are to prospectively investigate young patients ≤55 years admitted to hospital with radiologically diagnosed craniocervical arterial dissection compared to matched controls with stroke but not dissection, to identify risk factors and early presenting clinical features, so these may be more readily identified by primary care practitioners. Methods: Patients ≤ 55 years presenting to hospital with craniocervical arterial dissection and controls will have their medical records reviewed and be interviewed and questioned about possible risk factors, preceding events to admission such as recent neck trauma, and presenting clinical features including any preceding transient ischaemic features. Clinical assessment will include a connective tissue screening examination to identify subclinical connective tissue disorders. Radiology and blood screening will be reviewed for typical features and inflammatory markers. Functional outcome will be reviewed to determine the burden of the stroke. Discussion: This study will provide descriptive and comparative data on intrinsic and extrinsic risk factors for craniocervical arterial dissection and outline the typical clinical presentation, including the nature of early presenting features which might assist practitioners to identify those patients for whom vigorous manual therapy of the neck is inappropriate and alert them to those for whom immediate urgent medical care should be sought.
Keyword Orthopedics
Sport Sciences
Sport Sciences
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Health and Rehabilitation Sciences Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 26 Feb 2014, 20:14:46 EST by Ms Kate Rowe on behalf of School of Health & Rehabilitation Sciences