Explore the challenging diagnosis of spontaneous cervical artery dissection, its symptoms, and risk factors. Learn how to distinguish cervical artery dissection from stroke and discover management strategies including imaging techniques, anti-thrombotic therapy, and emergency department management.
Spontaneous cervical artery dissection can lead to various complications like stenosis, thromboembolism, aneurysm formation, or nerve compression.
Patients with SCAD may present with symptoms such as neck pain, headache, Horner syndrome, or pulsatile tinnitus, necessitating CTA for diagnosis and stroke prevention.
Deep dives
Overview of SCAD Pathology
Spontaneous cervical artery dissection (SCAD) involves a tear in the arterial wall layers of the carotid or vertebral arteries, leading to intramural hematoma, stenosis, occlusion, thromboembolism, aneurysm formation, or compression of surrounding nerves and vasculature. It is a common cause of strokes in young individuals, accounting for 15 to 24 percent of strokes in patients less than 45, with risk factors including connective tissue disorders and vascular disease.
Symptoms, Diagnosis, and Management of SCAD
Patients with SCAD may present with unilateral neck pain, headache, partial Horner syndrome, cranial neuropathies, or pulsatile tinnitus. Diagnosis typically involves CTA of the head and neck, with anti-thrombotic or antiplatelet therapy recommended for stroke prevention. In cases of stroke, including subarachnoid hemorrhage or ischemic stroke, treatment may involve neurosurgery consultation, blood pressure management, and potential endovascular interventions. Consultation with specialists is crucial for determining the best management approach for SCAD patients.