Abstract
Spontaneous dissection of cervical arteries (sCAD) is a major cause of ischemic stroke in young patients, with an incidence varying from 1.7 to 3/100,000/year for extracranial internal carotid artery (ICAD) and 1 to 1.9/100,000/year for extracranial vertebral artery (VAD). Reliable epidemiological data on stroke incidence related to sCAD are scarce in Italy. This study aims to evaluate the incidence, clinical features, and outcome of cerebrovascular events related to sCAD and spontaneous intracranial arteries dissections (sIAD) in the city of Pisa (Italy). We retrospectively analyzed consecutive patients admitted between December 1997 and June 2015 with a diagnosis of stroke, TIA, or Bernard-Horner syndrome due to acute cervical or intracranial artery dissection. Considering that our hospital collects presumptively all patients hospitalized with sCAD coming from the referral geographical area, data may provide a good approximation to real incidence of sCAD in our population. Clinical and radiological features, acute treatment and outcome were collected. Seventy-seven cases were included (mean age 48.1±10.4 years, range 23–77,72.7% males), 66 residents in the district of Pisa. Crude incidence rate of cerebrovascular events due to intra or extracranial dissection was 1.88/100,000/year. The incidence of ICAD was 0.80/100,000/year and 0.43/100,000/year for VAD. Stroke occurred in 76.6% of patients. VAD was more prone to cause ischemic stroke and present with cervical pain or focal signs (p < 0.01) than ICAD group, which had older age at onset. sIAD were more frequent in the posterior circle (p = 0.01) and more associated with ischemic lesions. A good outcome (mRS 0–2) was observed in 79% of patients. This is the first epidemiological attempt to investigate impact of sCAD and sIAD in Italy.
Similar content being viewed by others
References
Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8(7):668–678
Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, Pezzini A, Brandt T, Caso V, Touzé E, Metso A, Canaple S, Abboud S, Giacalone G, Lyrer P, Del Zotto E, Giroud M, Samson Y, Dallongeville J, Tatlisumak T, Leys D, Martin JJ, Cervical Artery Dissection Ischemic Stroke Patients (CADISP) Group (2011) Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology 77(12):1174–1181
Metso AJ, Metso M, Debette S et al (2012) Gender and cervical artery dissection. Eur J Neurol 19(4):594–602
Sikkema T, Uyttenboogaart M, Eshghi O, De Keyser J, Brouns R, van Dijk JM, Luijckx GJ (2014) Intracranial artery dissection. Eur J Neurol 21(6):820–826
Schievink WI, Wijdicks EF, Kulper JD (1998) Seasonal pattern of spontaneous cervical artery dissection. J Neurosurg 89:101–103
Kloss M, Metso A, Pezzini A, Leys D, Giroud M, Metso TM, Tatlisumak T, Lichy C, Bersano A, Abboud S, Grau A, Lyrer PA, Debette S, Dallongeville J, Martin J, Caso V, Grond-Ginsbach C, Engelter ST (2012) Towards understanding seasonal variability in cervical artery dissection (CeAD). J Neurol 259(8):1662–1667
Giossi A, Ritelli M, Costa P, Morotti A, Poli L, Del Zotto E, Volonghi I, Chiarelli N, Gamba M, Bovi P, Tomelleri G, Carletti M, Checcarelli N, Meneghetti G, Morra M, Chinaglia M, De Giuli V, Colombi M, Padovani A, Pezzini A (2014) Connective tissue anomalies in patients with spontaneous cervical artery dissection. Neurology 83(22):2032–2037
Béjot Y, Daubail B, Debette S, Durier J, Giroud M (2014) Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry. Int J Stroke 9(7):879–882
Huang YC, Chen YF, Wang YH, Tu YK, Jeng JS, Liu HM (2009) Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol 72(Suppl 2):S20–S27 discussion S27
Grond-Ginsbach C, Giossi A, Aksay SS, Engelter ST, Lyrer PA, Metso TM, Metso AJ, Tatlisumak T, Debette S, Leys D, Thijs V, Bersano A, Abboud S, Kloss M, Lichy C, Grau A, Pezzini A, Touzé E, CADISP group (2013) Elevated peripheral leukocyte counts in acute cervical artery dissection. Eur J Neurol 20(10):1405–1410
Micheli S, Paciaroni M, Corea F, Agnelli G, Zampolini M, Caso V (2010) Cervical artery dissection: emerging risk factors. Open Neurol J 4:50–55
Guillon B, Berthet K, Benslamia L, Bertrand M, Bousser MG, Tzourio C (2003) Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke 34(7):e79–e81
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Giannini, N., Ulivi, L., Maccarrone, M. et al. Epidemiology and cerebrovascular events related to cervical and intracranial arteries dissection: the experience of the city of Pisa. Neurol Sci 38, 1985–1991 (2017). https://doi.org/10.1007/s10072-017-3084-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-017-3084-5