Dissection of the epiaortic and intracranial arteries.

Dissection of epiaortic vessels is a rare event but can have serious clinical consequences such as ischaemic injury to the brain, cerebellum or, more rarely to the retina and is an important cause of stroke in young adults. The main clinical presentation is headache or neck pain, usually but not always associated with Horner syndrome or other local symptoms, followed by an ischemic event in the carotid or vertebral district. Very rarely, the dissection can extend to the intracranial vessels leading to subarachnoid hemorrhage. The time between the headache and the stroke is variable, ranging from a few seconds to weeks. Suspecting an arterial dissection in cases of unexplained head or neck pain in young patients is than crucial to avoid cerebrovascular events; the clinical suspect must be confirmed by ultrasound examination of the epiaortic vessels as a first screening exam, followed by an appropriate neuroimaging study. Treatment with anticoagulants, although not supported by randomized trials, is generally employed to prevent embolic events. The prognosis of stroke caused by arterial dissection does not differ from that of ischaemic events of other origin; the rate of recurrence is low and most patients have only one event in their live. Clinical research with multicenter recruitment is ongoing to provide more solid evidence on the management and prognosis of arterial dissections.