vertebral artery dissection


Summary: Splitting of the vessel wall in the VERTEBRAL ARTERY. Interstitial hemorrhage into the media of the vessel wall can lead to occlusion of the vertebral artery, aneurysm formation, or THROMBOEMBOLISM. Vertebral artery dissection is often associated with TRAUMA and injuries to the head-neck region but can occur spontaneously.

Top Publications

  1. Maroon J, Gardner P, Abla A, El Kadi H, Bost J. "Golfer's stroke": golf-induced stroke from vertebral artery dissection. Surg Neurol. 2007;67:163-8; discussion 168 pubmed
  2. Bartels E. Dissection of the extracranial vertebral artery: clinical findings and early noninvasive diagnosis in 24 patients. J Neuroimaging. 2006;16:24-33 pubmed
    ..Duplex color-flow imaging was valuable for the early diagnosis of extracranial vertebral artery dissection and for follow-up examinations...
  3. Metso T, Metso A, Salonen O, Haapaniemi E, Putaala J, Artto V, et al. Adult cervicocerebral artery dissection: a single-center study of 301 Finnish patients. Eur J Neurol. 2009;16:656-61 pubmed publisher
    ..This study provides evidence for the association of CAD with male sex, and possible association with smoking and migraine. Occlusion of the dissected artery, ICAD, and infection appear to be associated with poorer outcome. ..
  4. Schwartz N, Vertinsky A, Hirsch K, Albers G. Clinical and radiographic natural history of cervical artery dissections. J Stroke Cerebrovasc Dis. 2009;18:416-23 pubmed publisher
    ..This large series from a single institution highlights many of the features of CAD. A relatively benign course with low recurrence rate is supported, independent of the type and duration of antithrombotic therapy. ..
  5. Sharma A, Herrera B, Aronow H. Simultaneous spontaneous coronary and vertebral artery dissection in a postpartum woman. J Invasive Cardiol. 2010;22:E229-32 pubmed
    Spontaneous coronary and vertebral artery dissection are rare but life-threatening conditions. They are more prevalent in pregnant and postpartum women with few atherosclerotic risk factors than in the general population...
  6. Dittrich R, Rohsbach D, Heidbreder A, Heuschmann P, Nassenstein I, Bachmann R, et al. Mild mechanical traumas are possible risk factors for cervical artery dissection. Cerebrovasc Dis. 2007;23:275-81 pubmed
    ..CMT and recent infections alone failed to reach significance during the present investigation, presumably due to the relatively small sample size of the study cohort. ..
  7. Arnold M, Cumurciuc R, Stapf C, Favrole P, Berthet K, Bousser M. Pain as the only symptom of cervical artery dissection. J Neurol Neurosurg Psychiatry. 2006;77:1021-4 pubmed
    ..Of them, 12 had vertebral artery dissection, 3 had internal carotid dissection and 5 had multiple dissections...
  8. Dittrich R, Nassenstein I, Bachmann R, Maintz D, Nabavi D, Heindel W, et al. Polyarterial clustered recurrence of cervical artery dissection seems to be the rule. Neurology. 2007;69:180-6 pubmed
    ..The prognosis of recurring sCAD appears benign, particularly in patients already receiving antithrombotic therapy. ..
  9. Nyberg J, Olsson T, Malm J. [Carotid and vertebral artery dissection a common cause of stroke among younger persons. Minor trauma a precipitating factor in more than fifty percent according to a retrospective study]. Lakartidningen. 2007;104:24-8 pubmed

More Information


  1. Yeh H, Seak C, Chiu T, Chang Y. Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision. Am J Emerg Med. 2009;27:131.e1-3 pubmed publisher
    ..A considerable number of cases of Wallenberg syndrome were reported to be associated with vertebral artery dissection (VAD)...
  2. Silver B, Grover K, Arcila X, Mitsias P, Bowyer S, Chopp M. Recovery in a patient with locked-in syndrome. Can J Neurol Sci. 2006;33:246-9 pubmed
    ..Daily use of high dose sildenafil citrate appears to be safe in this patient with stroke resulting in locked-in syndrome. Further studies will be required to establish safety and efficacy. ..
  3. Arauz A, Hoyos L, Espinoza C, Cantu C, Barinagarrementeria F, Roman G. Dissection of cervical arteries: Long-term follow-up study of 130 consecutive cases. Cerebrovasc Dis. 2006;22:150-4 pubmed
    ..We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization. ..
  4. Nedeltchev K, Baumgartner R. Traumatic cervical artery dissection. Front Neurol Neurosci. 2005;20:54-63 pubmed
    ..Neurological outcome is probably worse in TCAD compared to spontaneous CAD, although it is unclear whether this is due to dissection-induced ischemic stroke or associated traumatic lesions. ..
  5. Liu C, Chang F, Hu H, Hsu L. Ipsilateral crural monoparesis in lateral medullary infarction due to vertebral artery dissection. Eur J Neurol. 2006;13:e8-9 pubmed
  6. Fischer U, Ledermann I, Nedeltchev K, Meier N, Gralla J, Sturzenegger M, et al. Quality of life in survivors after cervical artery dissection. J Neurol. 2009;256:443-9 pubmed publisher
    ..Impairment of QOL is a surprisingly frequent long-term sequela after sCAD and deserves attention as an outcome measure in these patients. ..
  7. Kim Y, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009;123:810-21 pubmed publisher
    ..Very ill patients at a high risk of ischemic stroke may have been given aspirin due to fear of hemorrhagic complications. A randomized controlled trial is planned and will be crucial to resolve this issue. ..
  8. Porto F, da Silva S, Orsini M, de Freitas M, de Freitas G. Hemimedullary infarct with ipsilateral hemiplegia: a vertebral artery dissection syndrome?. J Neurol Sci. 2009;278:135-7 pubmed publisher
    ..Hemimedullary syndrome accompanied by ipsilateral motor deficit should raise suspicion of dissection of the VA. ..
  9. Arnold M, Bousser M, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke. 2006;37:2499-503 pubmed
    ..about clinical, radiologic findings, clinical outcome, and its predictors in patients with spontaneous vertebral artery dissection (sVAD)...
  10. Lee J, Yong S, Bang O, Shin Y, Kim B, Kim S. Comparison of spontaneous intracranial vertebral artery dissection with large artery disease. Arch Neurol. 2006;63:1738-44 pubmed
    ..To compare clinical and angiographic characteristics and stroke patterns between spontaneous intracranial vertebral artery dissection (VAD) and vertebral large artery disease (LAD) (atherosclerosis). Retrospective study...
  11. Melki E, Nasser G, Vandendries C, Adams D, Ducreux D, Denier C. Congenital vertebral duplication: a predisposing risk factor for dissection. J Neurol Sci. 2012;314:161-2 pubmed publisher
    ..e.: fibromuscular dysplasias or carotid redundancies (including loops, kinks and coils). ..
  12. Kendi A, Brace J. Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings. Br J Radiol. 2009;82:e216-8 pubmed publisher
    ..This is the first case of vertebral artery duplication with cervical vertebral artery and intracranial aneurysms. ..
  13. Tsukahara T, Minematsu K. Overview of spontaneous cervicocephalic arterial dissection in Japan. Acta Neurochir Suppl. 2010;107:35-40 pubmed publisher
    ..Herein, we reviewed the current status of the management of SCAD in Japan, and clarified its clinical characteristics to establish an appropriate treatment. ..
  14. Kawchuk G, Jhangri G, Hurwitz E, Wynd S, Haldeman S, Hill M. The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation. J Neurol. 2008;255:371-7 pubmed publisher
    ..Two of the largest case series of vertebral artery dissection describing subjects with and without a specific history of cSMT were reassessed to determine which ..
  15. Kratz S, Butler K. Vertebral artery dissection presenting as acute cerebrovascular accident. J Emerg Med. 2011;40:151-7 pubmed publisher
    b>Vertebral artery dissection is a lesser known but significant cause of stroke in young, healthy people...
  16. Tinel D, Bliznakova E, Juhel C, Gallien P, Brissot R. Vertebrobasilar ischemia after cervical spine manipulation: a case report. Ann Readapt Med Phys. 2008;51:403-14 pubmed publisher
  17. Vertinsky A, Schwartz N, Fischbein N, Rosenberg J, Albers G, Zaharchuk G. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 2008;29:1753-60 pubmed publisher
    ..In many cases, MR imaging/MRA provided complementary or confirmatory information, particularly given its better depiction of ischemic complications. ..
  18. de Bray J, Marc G, Pautot V, Vielle B, Pasco A, Lhoste P, et al. Fibromuscular dysplasia may herald symptomatic recurrence of cervical artery dissection. Cerebrovasc Dis. 2007;23:448-52 pubmed
    ..Five patients had CAD recurrence (60% occurred late). Four of these 5 patients had FMD. In 4 patients, CAD recurrence involved another cervical artery. The rate of symptomatic CAD recurrence was 1% per year and was often related to FMD. ..
  19. Menon R, Kerry S, Norris J, Markus H. Treatment of cervical artery dissection: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2008;79:1122-7 pubmed publisher
    ..There is little evidence to support current treatment approaches in cervical dissection. Randomised controlled prospective trials, particularly assessing anticoagulation versus antiplatelet agents, are required. ..
  20. Reuter U, Hämling M, Kavuk I, Einhaupl K, Schielke E. Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. J Neurol. 2006;253:724-30 pubmed
    b>Vertebral artery dissection (VAD) has been observed in association with chirotherapy of the neck. However, most publications describe only single case reports or a small number of cases...
  21. Bacigaluppi S, Rusconi R, Rampini P, Annoni F, Zavanone M, Carnelli V, et al. Vertebral artery dissection in a child. Is "spontaneous" still an appropriate definition?. Neurol Sci. 2006;27:364-8 pubmed
    ..We here describe the case of a seven-year-old boy who developed a spontaneous vertebral artery dissection (VAD) leading to occipito-mesial, thalamo-capsular and cerebellar infarction...
  22. Lee V, Brown R, Mandrekar J, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology. 2006;67:1809-12 pubmed
    ..6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available...
  23. Wang C, Tsai W, Lo Y, Chen J, Wong A. Unilateral right occipital condyle to C2 level spinal cord infarction associated with ipsilateral vertebral artery stenosis and contralateral vertebral artery dissection: a case report. J Spinal Cord Med. 2011;34:118-21 pubmed
    ..To illustrate the clinical presentation, diagnosis, management, and outcome of unilateral right occipital condyle to C2 level spinal cord infarction...
  24. Pfefferkorn T, Saam T, Rominger A, Habs M, Gerdes L, Schmidt C, et al. Vessel wall inflammation in spontaneous cervical artery dissection: a prospective, observational positron emission tomography, computed tomography, and magnetic resonance imaging study. Stroke. 2011;42:1563-8 pubmed publisher
    ..053). A subset of patients with spontaneous CAD showed signs of a generalized transient inflammatory arteriopathy in contrast-enhanced hrMRI and PET-CT. This subset of patients may be more prone to multiple dissections. ..
  25. Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, et al. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012;79:686-9 pubmed publisher
    ..for superiority of anticoagulation or antiplatelet therapy in prevention of stoke after carotid and vertebral artery dissection; however, all data are from nonrandomized studies and randomized studies are required...
  26. Chen W, Chern C, Wu Y, Lee C. Vertebral artery dissection and cerebellar infarction following chiropractic manipulation. Emerg Med J. 2006;23:e1 pubmed
    b>Vertebral artery dissection (VAD) associated with chiropractic cervical manipulation is a rare but potentially disabling condition. In this report, we present a young patient manifesting with repeated vertigo...
  27. Caso V, Paciaroni M, Bogousslavsky J. Environmental factors and cervical artery dissection. Front Neurol Neurosci. 2005;20:44-53 pubmed
    ..manipulation of the neck has been associated with carotid artery dissection and, particularly, vertebral artery dissection. Another risk factor for spontaneous dissections seems to be a recent history of a respiratory tract ..
  28. Arauz A, Márquez J, Artigas C, Balderrama J, Orrego H. Recanalization of vertebral artery dissection. Stroke. 2010;41:717-21 pubmed publisher
    We investigated the predictors and time course for recanalization after vertebral artery dissection. We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection without intracerebral ..
  29. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009;8:668-78 pubmed publisher
    ..Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies. ..
  30. Debette S, Grond Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology. 2011;77:1174-81 pubmed publisher
    ..Patients observational study (n = 619 with internal carotid artery dissection [ICAD], n = 327 with vertebral artery dissection [VAD], n = 36 with ICAD and VAD). Patients with ICAD were older (p < 0.0001), more often men (p = 0...
  31. Dittrich R, Heidbreder A, Rohsbach D, Schmalhorst J, Nassenstein I, Maintz D, et al. Connective tissue and vascular phenotype in patients with cervical artery dissection. Neurology. 2007;68:2120-4 pubmed
    ..These findings argue against a clinically apparent connective tissue disorder underlying sCAD. The prevalence of known connective tissue diseases in sCAD patients is low. ..
  32. Thomas L, Rivett D, Attia J, Parsons M, Levi C. Risk factors and clinical features of craniocervical arterial dissection. Man Ther. 2011;16:351-6 pubmed publisher
    ..53). Cardiovascular risk factors for stroke were less evident in the dissection group (<1 factor per case) compared to the controls (>3). ..
  33. Haneline M, Lewkovich G. An analysis of the etiology of cervical artery dissections: 1994 to 2003. J Manipulative Physiol Ther. 2005;28:617-22 pubmed
    ..articles published from 1994 to 2003 using the search terms cervical artery dissection (CAD), vertebral artery dissection, and internal carotid artery dissection...
  34. Weber M, Gaul C, Tomandl B, Lang C. Persistent amnesia following right-sided vertebral artery dissection. J Neurol. 2004;251:624-5 pubmed
  35. Haldeman S, Kohlbeck F, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine (Phila Pa 1976). 2002;27:49-55 pubmed
    ..Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach. ..
  36. Czechowsky D, Hill M. Neurological outcome and quality of life after stroke due to vertebral artery dissection. Cerebrovasc Dis. 2002;13:192-7 pubmed
    b>Vertebral artery dissection is a well-recognized cause of posterior circulation stroke for which there is relatively little information on long-term outcomes. Quality of life (QOL) is an important patient-centred outcome measure...
  37. Nadgir R, Loevner L, Ahmed T, Moonis G, Chalela J, Slawek K, et al. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 2003;45:311-4 pubmed
    ..We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation.
  38. Quintana J, Drew E, Richtsmeier T, Davis L. Vertebral artery dissection and stroke following neck manipulation by Native American healer. Neurology. 2002;58:1434-5 pubmed
  39. Volker W, Besselmann M, Dittrich R, Nabavi D, Konrad C, Dziewas R, et al. Generalized arteriopathy in patients with cervical artery dissection. Neurology. 2005;64:1508-13 pubmed
    ..Limiting factors of the study are that some control biopsies were obtained from autopsies and that the anticoagulation status of patients and controls were not completely comparable. ..
  40. Cimini N, D Andrea P, Gentile M, Berletti R, Ferracci F, Candeago R, et al. Cervical artery dissection: a 5-year prospective study in the Belluno district. Eur Neurol. 2004;52:207-10 pubmed
    ..The treatment of choice consists of anticoagulants. An early clinical diagnosis, strongly supported by radiological tests, is mandatory to start the proper treatment and achieve the best possible outcome. ..
  41. Dziewas R, Konrad C, Dräger B, Evers S, Besselmann M, Ludemann P, et al. Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 2003;250:1179-84 pubmed
    ..Patients with dissection-related cervical artery occlusion had a significantly increased risk of suffering a disabling stroke...
  42. Rubinstein S, Peerdeman S, van Tulder M, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005;36:1575-80 pubmed
    ..Only one study (of homocysteine) used healthy controls, a robust sample size, and had a low risk of biased results. The relationship between atherosclerosis and CAD has been insufficiently examined. ..
  43. Caso V, Paciaroni M, Corea F, Hamam M, Milia P, Pelliccioli G, et al. Recanalization of cervical artery dissection: influencing factors and role in neurological outcome. Cerebrovasc Dis. 2004;17:93-7 pubmed
    ..Recanalization appeared to be a spontaneous mechanism, which could have depended on the intrinsic condition of the vessels. Finally, neurological outcome was dependent on lesion localization and the presence of good collaterals. ..
  44. Guillon B, Berthet K, Benslamia L, Bertrand M, Bousser M, Tzourio C. Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke. 2003;34:e79-81 pubmed
    ..1 to 8.2; P=0.032). This association was stronger in patients with multiple (odds ratio, 6.4) than single artery (odds ratio, 2.1) dissection. Recent infection is a risk factor and could be a trigger for SCAD. ..
  45. Pezzini A, Del Zotto E, Padovani A. Hyperhomocysteinemia: a potential risk factor for cervical artery dissection following chiropractic manipulation of the cervical spine. J Neurol. 2002;249:1401-3 pubmed
    ..Hyperhomocysteinemia may represent a potential risk factor for manipulation-related CAD, leading to structural abnormalities of the arterial wall and increasing the susceptibility to mechanical stress. ..
  46. Rothwell D, Bondy S, Williams J. Chiropractic manipulation and stroke: a population-based case-control study. Stroke. 2001;32:1054-60 pubmed
    ..The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment. Because of the popularity of spinal manipulation, high-quality research on both its risks and benefits is recommended. ..
  47. Oehler J, Gandjour J, Fiebach J, Schwab S. [Bilateral vertebral artery dissection after chiropractic treatment]. Orthopade. 2003;32:911-3; discussion 914-5 pubmed
    ..A dissection of both vertebral arteries could be demonstrated by MR tomography. This case report should alert therapists to be aware of vertebrobasilar complications after spinal manipulations. ..
  48. Nazir F, Muir K. Prolonged interval between vertebral artery dissection and ischemic stroke. Neurology. 2004;62:1646-7 pubmed
  49. Tzourio C, Benslamia L, Guillon B, Aidi S, Bertrand M, Berthet K, et al. Migraine and the risk of cervical artery dissection: a case-control study. Neurology. 2002;59:435-7 pubmed
    ..6; 1.5 to 8.6, p = 0.005). This result supports the hypothesis that an underlying arterial wall disease could be a predisposing condition for migraine. ..
  50. Mokri B. Headaches in cervical artery dissections. Curr Pain Headache Rep. 2002;6:209-16 pubmed
    ..The spectrum of clinical presentations of these dissections is broad. Many patients, especially those with ICA dissections, may never develop a stroke. ..
  51. Galende A, Camacho A, Gómez Escalonilla C, Penas M, Juntas R, Ramos A, et al. Lateral medullary infarction secondary to vertebral artery dissection presenting as a trigeminal autonomic cephalalgia. Headache. 2004;44:70-4 pubmed
    ..A bilateral vertebral artery dissection was demonstrated...
  52. Karimi M, Razavi M, Fattal D. Rubral lateropulsion due to vertebral artery dissection in a patient with Klippel-Feil syndrome. Arch Neurol. 2004;61:583-5 pubmed
    ..Neurologic deficits in patients with Klippel-Feil syndrome usually are attributed to direct compression of neuronal structures or hypoperfusion secondary to compression of the vertebral arteries by bony abnormalities...
  53. Haldeman S, Carey P, Townsend M, Papadopoulos C. Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: the effect of referral bias. Spine J. 2002;2:334-42 pubmed
    ..Recent surveys have reported that many neurologists will encounter cases of vertebral artery dissection that occur at various times after cervical manipulation, whereas most practitioners of spinal ..