Dissections of Cervical Arteries – Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre

ABSTRACT

Dissections of the cervical arteries are among the most frequent causes of juvenile strokes. The etiology and pathogenesis of spontaneous dissections remain elusive. Best treatment remains to be defined. Here, we analyzed 71 consecutive patients from the Department of Neurology, University Hospital of Jena. We asked if immediate anticoagulation or alternative treatment with ASA would affect outcome. Patients treated initially with i.v. ASA tended to have a better outcome than patients who were anticoagulated (r=0.3; p<0.05). In heparin treated patients, an initial i.v. bolus shortened the interval before the target PTT was reached by 1.3 days (p<0.05), yet did not affect neurological outcome. Low NIHSS (National Institute of Health Stroke Scale) (r=-0.71; p<0.01) and high Barthel scores (r=0,77; p<0.01) at presentation predicted a good outcome. In 14 of 52 patients, low TSH (thyroid- stimulating hormone) indicated hyperthyreosis, while no patient was hypothyreotic. In 33 of 64 patients CRP (C-reactive protein) was elevated. These findings merit validation in larger trials.

Keywords:

Dissection, vertebral artery (VA), internal carotid artery (ICA), stroke, anticoagulation, platelet aggregationinhibition.