Cervical artery dissection - a cause of stroke in young adults

What is Cervical Artery Dissection?

Four blood vessels supply the blood to our brain. Two carotid arteries that supply the front and two vertebral arteries that supply the back. Together these four vessels are known as the cervical arteries.

Cervical artery dissection is a flap-like tear of the inner lining of the artery wall. After the tear, blood enters the vessel wall and forms a blood clot. The blood clot can continue to grow until it is so big it does not allow blood to continue to flow through it to the brain, which can cause an ischemic stroke. Pieces of the clot can break off and travel up the bloodstream to the brain and prevent blood flow, also leading to ischemic stroke.

Ischemic stroke is brain cell death because blood and nutrients are unable to reach the tissue due to an artery blockage. The symptoms of stroke depend on the area of brain that is damaged. Stroke from cervical artery dissection often have symptoms of headache, neck and face pain, visual changes like double vision, whooshing sound in one ear or weakness on one side of the body. Often symptom onset is slow and can occur over hours to days.

How Cervical Artery Dissection Occurs

Cervical artery dissection occurs infrequently, but is a leading cause of stroke in patients younger than 45 years that are otherwise healthy. Damage to the arterial wall can occur spontaneously, with trauma or even minor injury involving cervical distortion better known as “whiplash.”

Spontaneous dissection is the term used to describe all cases that are not involved with blunt or penetrating trauma. Many patients report a history of trivial or minor injury, but the diagnosis of traumatic dissection is for those with a significant trauma including motor vehicle accidents, falls or penetrating injuries.

Cervical Artery Dissection Risk Factors

Several risk factors have been associated with developing cervical artery dissection:

• Spinal manipulation
• Artery hypoplasia (underdeveloped artery) 
• High blood pressure 
• Smoking 
• Genetic risk factors, including hereditary connective tissue disorders (Ehlers-Danlos syndrome, Marfans syndrome and fibromuscular dysplasia) 
• Minor trauma from things like riding on roller coasters, carrying a heavy bag across your chest and on your neck, lifting weights. Most artery dissections from minor trauma affect the vertebral arteries and it is speculated they are more vulnerable to injury as it goes into the base of the skull  

Anyone with suspected cervical artery dissection should seek immediate medical evaluation in an emergency department. Brain imaging by CT angiography is completed to evaluate the cervical blood vessels of the neck and head and evaluation of brain tissue for evidence of ischemic stroke.