Carotid and vertebral arterial dissections in the emergency department.

Although carotid and vertebral (cervical) arterial dissections are not common presentations to the emergency department, timely and appropriate diagnostic strategies will allow early initiation of effective treatment therapies. Cervical arterial dissection occurs when the intimal wall of an artery is damaged as a result of trauma or defect. As blood fills the layers of the arterial wall, thrombi form, which can lead to stroke, pseudoaneurysm, vessel occlusion, and stroke. Intracranial dissections may result in subarachnoid hemorrhage. Because cervical arterial dissections may present with common signs and symptoms such as headache, neck pain, neurological deficits, and stroke, it is essential that dissection be considered early and ruled out quickly. Computed tomographic angiography, magnetic resonance angiography, and digital subtraction angiography may be used for diagnosis. Anticoagulation or antiplatelet therapy is the mainstay of treatment for spontaneous or traumatic dissections and will reduce the risk of stroke. Endovascular therapy or surgery may be indicated. Recurrence or rebleeding is a significant risk and must be managed.