Manja Kloss1, Caspar Grond-Ginsbach2, Peter Ringleb2, Ingrid Hausser2, Werner Hacke2, Tobias Brandt2. 1. From the Department of Neurology (M.K., C.G.-G., P.R., W.H.), University of Heidelberg; Institute of Pathology IPH (I.H.), Heidelberg University Hospital, Germany; and Suva/Swiss National Accident Insurance Fund (T.B.), Lucerne, Switzerland. Manja.Kloss@med.uni-heidelberg.de. 2. From the Department of Neurology (M.K., C.G.-G., P.R., W.H.), University of Heidelberg; Institute of Pathology IPH (I.H.), Heidelberg University Hospital, Germany; and Suva/Swiss National Accident Insurance Fund (T.B.), Lucerne, Switzerland.
Abstract
OBJECTIVE: To explore the recurrence of cervical artery dissection (CeAD). METHODS: A single-center consecutive series of 282 CeAD patients was prospectively recruited during first admission from 1995 to 2012. Patients with a follow-up of at least 1 year (n = 238) were eligible for the current analysis. All patients with clinical symptoms or signs of recurrent CeAD on ultrasound were examined by MRI. Dermal connective tissue morphology was studied in 108 (45.4%) patients. RESULTS: Median follow-up was 52 months (range 12-204 months). In all, 221 (92.8%) patients presented with monophasic CeAD, including 188 (79.0%) patients with a single CeAD event, 11 (4.6%) with simultaneous dissections in multiple cervical arteries, and 22 (9.2%) with subsequent events within a single phase of 4 weeks. Seventeen patients (7.1%) had late (>1 month after the initial event) recurrent CeAD events, including 5 (2.1%) with multiple recurrences. Patients with late recurrences were younger (37.5 ± 6.9 years) than those without (43.8 ± 9.9; p = 0.011). Ischemic stroke occurred in 164 (68.9%) patients at first diagnosis, but only 4 of 46 (8.7%) subsequent events caused stroke (p < 0.0001), while 19 (41.3%) were asymptomatic. Connective tissue abnormalities were found in 54 (56.3%) patients with monophasic and 8 (66.7%) with late recurrent dissections (p = 0.494). CONCLUSION: Twenty-two (9.2%) patients had new CeAD events within 1 month and 17 (7.1%) later recurrences. The risk for new events was significantly higher (about 60-fold) during the acute phase than during later follow-up. Connective tissue abnormalities were not more frequent in patients with late recurrent events than in those with monophasic CeAD.
OBJECTIVE: To explore the recurrence of cervical artery dissection (CeAD). METHODS: A single-center consecutive series of 282 CeADpatients was prospectively recruited during first admission from 1995 to 2012. Patients with a follow-up of at least 1 year (n = 238) were eligible for the current analysis. All patients with clinical symptoms or signs of recurrent CeAD on ultrasound were examined by MRI. Dermal connective tissue morphology was studied in 108 (45.4%) patients. RESULTS: Median follow-up was 52 months (range 12-204 months). In all, 221 (92.8%) patients presented with monophasic CeAD, including 188 (79.0%) patients with a single CeAD event, 11 (4.6%) with simultaneous dissections in multiple cervical arteries, and 22 (9.2%) with subsequent events within a single phase of 4 weeks. Seventeen patients (7.1%) had late (>1 month after the initial event) recurrent CeAD events, including 5 (2.1%) with multiple recurrences. Patients with late recurrences were younger (37.5 ± 6.9 years) than those without (43.8 ± 9.9; p = 0.011). Ischemic stroke occurred in 164 (68.9%) patients at first diagnosis, but only 4 of 46 (8.7%) subsequent events caused stroke (p < 0.0001), while 19 (41.3%) were asymptomatic. Connective tissue abnormalities were found in 54 (56.3%) patients with monophasic and 8 (66.7%) with late recurrent dissections (p = 0.494). CONCLUSION: Twenty-two (9.2%) patients had new CeAD events within 1 month and 17 (7.1%) later recurrences. The risk for new events was significantly higher (about 60-fold) during the acute phase than during later follow-up. Connective tissue abnormalities were not more frequent in patients with late recurrent events than in those with monophasic CeAD.
Authors: Philipp Erhart; Daniel Körfer; Susanne Dihlmann; Jia-Lu Qiao; Ingrid Hausser; Peter Ringleb; Jörg Männer; Nicola Dikow; Christian P Schaaf; Caspar Grond-Ginsbach; Dittmar Böckler Journal: J Clin Med Date: 2022-06-07 Impact factor: 4.964
Authors: Christopher Traenka; Manja Kloss; Tim Strom; Philippe Lyrer; Tobias Brandt; Leo H Bonati; Caspar Grond-Ginsbach; Stefan Engelter Journal: Eur Stroke J Date: 2019-07-12
Authors: Elizabeth Lounsbury; Brian Dewar; Alexandra Davis; Dean A Fergusson; Dar Dowlatshahi; Michel Shamy Journal: BMJ Open Date: 2020-09-13 Impact factor: 2.692