Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Stéphanie Debette, Annette Compter, Marc Antoine Labeyrie, Maarten Uyttenboogaart, Tina M. Metso, Jennifer J. Majersik, Barbara Goeggel-Simonetti, Stefan T. Engelter, Alessandro Pezzini, Philippe Bijlenga, Andrew M. Southerland, Olivier Naggara, Yannick Béjot, John W. Cole, Anne Ducros, Giacomo Giacalone, Sabrina Schilling, Peggy Reiner, Hakan Sarikaya, Janna C. WelleweerdL. Jaap Kappelle, Gert Jan de Borst, Leo H. Bonati, Simon Jung, Vincent Thijs, Juan J. Martin, Tobias Brandt, Caspar Grond-Ginsbach, Manja Kloss, Tohru Mizutani, Kazuo Minematsu, James F. Meschia, Vitor M. Pereira, Anna Bersano, Emmanuel Touzé, Philippe A. Lyrer, Didier Leys, Hugues Chabriat, Hugh S. Markus, Bradford B. Worrall, Stéphane Chabrier, Ralph Baumgartner, Christian Stapf, Turgut Tatlisumak, Marcel Arnold, Marie Germaine Bousser

Research output: Contribution to journalReview article

132 Scopus citations

Abstract

Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.

Original languageEnglish (US)
Pages (from-to)640-654
Number of pages15
JournalThe Lancet Neurology
Volume14
Issue number6
DOIs
StatePublished - Jun 1 2015

ASJC Scopus subject areas

  • Clinical Neurology

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    Debette, S., Compter, A., Labeyrie, M. A., Uyttenboogaart, M., Metso, T. M., Majersik, J. J., Goeggel-Simonetti, B., Engelter, S. T., Pezzini, A., Bijlenga, P., Southerland, A. M., Naggara, O., Béjot, Y., Cole, J. W., Ducros, A., Giacalone, G., Schilling, S., Reiner, P., Sarikaya, H., ... Bousser, M. G. (2015). Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. The Lancet Neurology, 14(6), 640-654. https://doi.org/10.1016/S1474-4422(15)00009-5