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Rosalik KF, Havemann LM, Wasickanin ME, McCaulley JA, Edwards SM, Leonard KM. Vertebral artery dissection in relation to pregnancy: a case series and literature review. AJOG GLOBAL REPORTS 2023; 3:100281. [PMID: 38046533 PMCID: PMC10692729 DOI: 10.1016/j.xagr.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Cervical artery dissection is an uncommon condition for which pregnancy and postpartum states confer increased risk. Although the majority of patients with this condition fully recover, including resolution of the dissection on imaging, long-term sequelae include a variety of cardiovascular conditions that may be associated with high rates of morbidity and mortality. Here, we review 2 cases of vertebral artery dissection in relation to pregnancy. Our first case will review the management of a pregnant patient with a history of vertebral artery dissection; whereas our second case reviews a presentation of postpartum vertebral artery dissection. Providers should maintain a high suspicion of cervical artery dissection in pregnant and postpartum patients presenting with headache and neck pain.
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Affiliation(s)
- Kendal F. Rosalik
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Logan M. Havemann
- Department of Obstetrics and Gynecology, Carl R. Darnall Army Medical Center, Fort Hood, TX (Dr Havemann)
| | - Morgan E. Wasickanin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Jill A. McCaulley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Sarah M. Edwards
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA (Drs Rosalik, Wasickanin, McCaulley, and Edwards)
| | - Katherine M. Leonard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Womack Army Medical Center, Fort Bragg, NC (Dr Leonard)
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Tentolouris-Piperas V, Lymperopoulos L, Tountopoulou A, Vassilopoulou S, Mitsikostas DD. Headache Attributed to Reversible Cerebral Vasoconstriction Syndrome (RCVS). Diagnostics (Basel) 2023; 13:2730. [PMID: 37685270 PMCID: PMC10487016 DOI: 10.3390/diagnostics13172730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a condition with variable outcomes presenting a new onset thunderclap headache accompanied by focal neurological symptoms or seizures. It can be idiopathic or arise secondarily to a variety of trigger factors. The condition is increasingly recognized in clinical practice, but many facets remain poorly understood. This article aims to clarify the headache characteristics in RCVS, the temporal association of angiographic findings, the potential association of the condition with SARS-CoV-2 infection, and the clinical presentation of RCVS in children and is based on a systematic PRISMA search for published analytical or large descriptive observational studies. Data from 60 studies that fulfilled specific criteria were reviewed. Most people with RCVS exhibit a typical thunderclap, explosive, or pulsatile/throbbing headache, or a similar acute and severe headache that takes longer than 1 min to peak. Atypical presentations or absence of headaches are also reported and may be an underrecognized phenotype. In many cases, headaches may persist after resolution of RCVS. Focal deficits or seizures are attributed to associated complications including transient ischemic attacks, posterior reversible encephalopathy syndrome, ischemic stroke, cerebral edema, and intracranial hemorrhage. The peak of vasoconstriction occurs usually within two weeks after clinical onset, possibly following a pattern of centripetal propagation, and tends to resolve completely within 3 months, well after symptoms have subsided. There are a few reports of RCVS occurring in relation to SARS-CoV-2 infection, but potential underlying pathophysiologic mechanisms and etiological associations have not been confirmed. RCVS occurs in children most often in the context of an underlying disease. Overall, the available data in the literature are scattered, and large-scale prospective studies and international collaborations are needed to further characterize the clinical presentation of RCVS.
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Affiliation(s)
| | | | | | | | - Dimos D. Mitsikostas
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (V.T.-P.); (L.L.); (A.T.); (S.V.)
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3
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Li H, Xu S, Xu B, Zhang Y, Yin J, Yang Y. Unraveling the Links between Chronic Inflammation, Autoimmunity, and Spontaneous Cervicocranial Arterial Dissection. J Clin Med 2023; 12:5132. [PMID: 37568534 PMCID: PMC10419694 DOI: 10.3390/jcm12155132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
Advances in imaging techniques have led to a rise in the diagnosis of spontaneous cervicocranial arterial dissection (SCCAD), which is now considered a common cause of stroke in young adults. However, our understanding of the pathophysiological mechanisms underlying SCCAD remains limited. Prior studies have proposed various factors contributing to arterial wall weakness or stress as potential causes for SCCAD. A combination of biopsies, case reports, and case-control studies suggests that inflammatory changes and autoimmunity may play roles in the cascade of events leading to SCCAD. In this review, we examine the close relationship between SCCAD, chronic inflammation, and autoimmune diseases, aiming to explore potential underlying pathophysiological mechanisms connecting these conditions. While some relevant hypotheses and studies exist, direct evidence on this topic is still relatively scarce. Further investigation of the underlying mechanisms in larger clinical cohorts is needed, and the exploration of animal models may provide novel insights.
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Affiliation(s)
- Hao Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Shiyao Xu
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Beibei Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
| | - Yutong Zhang
- The Institute of Neuroscience, Soochow University, Suzhou 215006, China; (S.X.); (Y.Z.)
| | - Jun Yin
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yi Yang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; (H.L.); (B.X.)
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4
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Abdelnour LH, Kurdy M, Idris A. Systematic review of postpartum and pregnancy-related cervical artery dissection. J Matern Fetal Neonatal Med 2022; 35:10287-10295. [PMID: 36176066 DOI: 10.1080/14767058.2022.2122799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cervical artery dissection (CeAD) is responsible of one fifth of cases of ischemic stroke, but is uncommon during pregnancy or the early postpartum period and evidence is derived from published case reports and case series. OBJECTIVES This systematic review with a prospectively registered protocol was conducted to study the clinical presentation, management and prognosis of this condition. METHODS Ovid-Medline, PubMed Central, and CINAHL were searched without language restriction. RESULTS Fifty-seven articles (50 case reports and seven case series) reporting on 77 patients were included. The mean age was 33.7 years. The main possible risk factors identified were migraine, hyperlipidemia, connective tissue disorders, preeclampsia and eclampsia, HELLP syndrome and prolonged second stage of labor. Headache was the most frequent symptom, followed by neck pain. Acute medical treatments included anticoagulation, antiplatelets, and endovascular therapy. No patients received thrombolysis. The overall prognosis was good with 77.8% of patients making full clinical recovery. CONCLUSIONS Cervical artery dissection is a rare, but an important complication of pregnancy and puerperium. Diagnosis requires a high index of suspicion. The strong association with hypertensive and connective tissue disorders requires further research.
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Sano K, Kuge A, Kondo R, Yamaki T, Homma H, Saito S, Sonoda Y. Postpartum reversible cerebral vasoconstriction with cortical subarachnoid hemorrhage and posterior reversible encephalopathy syndrome concomitant with vertebral artery dissection diagnosed by
MRI MSDE
method: A case report and review of literature. Clin Case Rep 2022; 10:e6257. [PMID: 36110331 PMCID: PMC9465692 DOI: 10.1002/ccr3.6257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/11/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022] Open
Abstract
Headache is one of the most common symptoms encountered during the postpartum period. The cause may be unknown, or the following illnesses are possible: cervical artery dissection (CAD), reversible posterior cerebral encephalopathy syndrome (PRES), and reversible cerebral vasoconstrictor syndrome (RCVS). It is suggested that they are interrelated and share a similar mechanism such as small vessel endothelial dysfunction, deficiencies in self‐regulation, and decreased sympathetic innervation of the posterior circulation. However, there are few reports of neuroradiological findings. We experienced a rare case of multiple postpartum vascular disease occurring at the same time. A 38‐year‐old woman suddenly developed thunderclap headache after giving birth. She was clear and had no neuropathy. Computed tomography revealed subarachnoid hemorrhage, including the cortical surface of the frontal lobe. Magnetic resonance image fluid‐attenuated inversion recovery revealed high‐intensity area in the bilateral basal ganglia and right occipital cortex. Angiography showed “string sausage” and extracranial left vertebral artery stenosis, but no aneurysm. Based on the clinical course and neuroradiological findings, we diagnosed her as postpartum vascular disease including CAD, PRES, RCVS, and cortical subarachnoid hemorrhage (SAH). Three‐dimensional black blood T1‐weighted images using a motion‐sensitized driven equilibrium three‐dimensional turbo spin echo (MSDE) sequencing method revealed an intramural hematoma consistent with the extracranial vertebral artery. After 3 months, MSDE lost its abnormal signal. Our case was rare in that multiple phenomena of postpartum vascular disease occurred at the same time. In particular, we could reveal that this speculation was reversible in the MRI MSDE sequencing.
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Affiliation(s)
- Kenshi Sano
- Department of Neurosurgery Yamagata City Hospital Saiseikan Yamagata Japan
| | - Atsushi Kuge
- Department of Neurosurgery Yamagata City Hospital Saiseikan Yamagata Japan
- Department of Emergency Medicine Yamagata City Hospital Saiseikan Yamagata Japan
| | - Rei Kondo
- Department of Neurosurgery Yamagata City Hospital Saiseikan Yamagata Japan
| | - Tetsu Yamaki
- Department of Neurosurgery Yamagata City Hospital Saiseikan Yamagata Japan
| | - Hiroshi Homma
- Department of Neurosurgery Yamagata City Hospital Saiseikan Yamagata Japan
| | - Shinjiro Saito
- Department of Neurosurgery Yamagata City Hospital Saiseikan Yamagata Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery Yamagata University, School of Medicine Yamagata Japan
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6
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Urrutia F, Mazzon E, Brunser A, Diaz V, Calderon JF, Stecher X, Bernstein T, Zuñiga P, Schilling A, Muñoz Venturelli P. Cervical Artery Dissection in Postpartum Women after Cesarean and Vaginal Delivery. J Stroke Cerebrovasc Dis 2022; 31:106572. [PMID: 35716521 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND AIMS Cervical artery dissection (CAD) is an infrequent but potentially disabling and fatal disease, accounting for up to 25 % of strokes in young adults. Pregnancy-related hormonal changes and increased hemodynamic stress on artery walls during vaginal delivery have been associated to CAD. We aim to describe a series of women presenting CAD during postpartum (PP) after cesarean and vaginal delivery. METHODS CAD women admitted to one hospital in Santiago, Chile, between July 2018 and October 2020 were included in a prospective cohort. Demographic, clinical and imaging data were registered for the PP group. RESULTS Sixty-seven women were diagnosed with CAD, from which 10 were PP. Seven women had cesarean section and 3 had vaginal delivery. They presented CAD related symptoms after a median of 10.5 (IQR 5-15) days from delivery. All of them had headache as initial symptom, 9 presented cervical pain and 8 had a family history of stroke. Four patients presented preeclampsia during pregnancy. Acute treatment consisted mostly in antiplatelet agents and analgesics. None of these patients had a CAD related stroke. Demographic, clinical and imaging characteristics of these women with CAD during PP are described. CONCLUSIONS This case series underpins the importance of clinical suspicion of CAD after delivery, highlighting the fact that CAD is not limited to women with vaginal delivery, thus alternative causes beyond acute hemodynamic stress could be involved. Further research is required to determine genetic components, along with deeper knowledge of modulating factors related to CAD in this setting.
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Affiliation(s)
- Francisca Urrutia
- Clinical Research Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Chile
| | - Enrico Mazzon
- Clinical Research Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Chile; Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Alejandro Brunser
- Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Department of General Emergency, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Violeta Diaz
- Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Juan Francisco Calderon
- Genetic and Genomic Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Ximena Stecher
- Department of Imaging, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Tomas Bernstein
- Department of Imaging, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Paulo Zuñiga
- Department of Imaging, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Andrea Schilling
- Department of Pediatrics and Ginecology, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Paula Muñoz Venturelli
- Clinical Research Center, Institute of Sciences and Innovation in Medicine, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Chile; Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Faculty of Medicine Clínica Alemana Universidad del Desarrollo, Santiago, Chile; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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7
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Alfonso F, García-Guimaraes M, Alvarado T, Sanz-Ruiz R, Roura G, Amat-Santos IJ, Abdul-Jawad Altisent O, Tizón-Marcos H, Flores-Ríos X, Masotti M, Pérez-de Prado A, Ferre GF, Ruiz-Poveda FL, Valero E, Portero-Portaz JJ, Diez-Villanueva P, Salamanca J, Bastante T, Rivero F. Clinical implications of arterial hypertension in patients with spontaneous coronary artery dissection. Coron Artery Dis 2022; 33:75-80. [PMID: 33878074 DOI: 10.1097/mca.0000000000001043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome. Many patients with SCAD have associated coronary risk factors. However, the implications of arterial hypertension in SCAD patients remain unknown. OBJECTIVE This study sought to assess the clinical implications of arterial hypertension in a nationwide cohort of patients with SCAD. METHODS The Spanish SCAD registry (NCT03607981) prospectively enrolled 318 consecutive patients. All coronary angiograms were centrally analyzed to confirm the diagnosis of SCAD. Patients were classified according to the presence of arterial hypertension. RESULTS One-hundred eighteen patients (37%) had a diagnosis of arterial hypertension. Hypertensive SCAD patients were older (60 ± 12 vs. 51 ± 9 years old) and had more frequently dyslipidemia (56 vs. 23%) and diabetes (9 vs. 3%) but were less frequently smokers (15 vs. 35%) than normotensive SCAD patients (all P < 0.05). Most patients in both groups were female (90 vs. 87%, NS) and female patients with hypertension were more frequently postmenopausal (70 vs. 47%, P < 0.05). Hypertensive SCAD patients had more severe lesions and more frequently multivessel involvement (15 vs. 7%, P < 0.05) and coronary ectasia (19 vs. 7%, P < 0.05) but showed a similar prevalence of coronary tortuosity (34 vs. 26%, NS). Revascularization requirement was similar in both groups (17 vs. 26%, NS) but procedural success was significantly lower (65 vs. 88%, P < 0.05) and procedural-related complications more frequent (65 vs. 41%, P < 0.05) in SCAD patients with hypertension. CONCLUSION Patients with SCAD and hypertension are older, more frequently postmenopausal and have more coronary risk factors than normotensive SCAD patients. During revascularization SCAD patients with hypertension obtain poorer results and have a higher risk of procedural-related complications (NCT03607981).
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Affiliation(s)
- Fernando Alfonso
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Marcos García-Guimaraes
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Teresa Alvarado
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Ricardo Sanz-Ruiz
- Cardiac Department, Hospital General Universitario Gregorio Marañón, IIS-GM, CIBERCV, Madrid
| | - Gerard Roura
- Cardiac Department, Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Barcelona
| | | | | | - Helena Tizón-Marcos
- Cardiac Department, Hospital del Mar - Parc de Salut Mar
- Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM, Barcelona
| | - Xacobe Flores-Ríos
- Cardiac Department, Complexo Hospitalario Universitario de A Coruña, A Coruña
| | - Mónica Masotti
- Cardiac Department, Hospital Clinic de Barcelona, Barcelona
| | | | | | | | | | | | - Pablo Diez-Villanueva
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Jorge Salamanca
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Teresa Bastante
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
| | - Fernando Rivero
- Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Universidad Autónoma de Madrid, CIBERCV, Madrid
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8
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Assif M, Lamy C, De Gaalon S, Caroit Y, Bourcier R, Preterre C, Guillon B. Cervical Artery Dissection in Young Women: Risk of Recurrence During Subsequent Pregnancies. Neurol Clin Pract 2022; 11:e803-e808. [PMID: 34992962 DOI: 10.1212/cpj.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
Objectives To assess the risk of recurrence of cervical artery dissection (CAD) during pregnancy and puerperium in women with a history of CAD and then help physicians with providing medical information to women who wish to become pregnant. Methods Women aged 16-45 years who were admitted to our center for a CAD between 2005 and 2017 were identified from the hospital database, and those with spontaneous and symptomatic CAD were included. They were then contacted to answer a questionnaire that was specifically designed in regard to the recurrence of CAD and pregnancies after the primary CAD. Results Ninety-one patients satisfied our inclusion criteria, and 89 were included in the analysis. During a median follow-up of 7.0 years, 4 women (4.4%) had recurrent CAD, although none during pregnancy or puerperium. Eighteen women (20%) had a total of 20 full-term pregnancies, occurring at least 6 months after CAD. Of these 20 pregnancies, 13 (65%) were vaginal deliveries, and 7 (35%) were cesarean sections. The reason for the absence of pregnancies after the initial CAD was unrelated to the vascular event in 89% of cases, but 8% of the women had been advised by a physician to avoid any future pregnancy or they had been recommended to undergo abortion or sterilization. Conclusion In this study, there were no CAD recurrences during subsequent pregnancies or postpartum, irrespective of the type of delivery. Thus, pregnancy after a history of CAD appears to be safe.
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Affiliation(s)
- Myriam Assif
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Catherine Lamy
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Solène De Gaalon
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Yolande Caroit
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Romain Bourcier
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Cécile Preterre
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
| | - Benoit Guillon
- Stroke Unit (MA, SDG, CP, BG), Nantes University Hospital; Department of Neurology (CL), Paris Descartes University, Hôpital Sainte-Anne, Paris; Department of Obstetrics and Gynecology (YC), Nantes University Hospital; Department of Neuroradiology (RB), Nantes University Hospital, France
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9
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Reversible Cerebral Vasoconstriction Syndromes. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Kalashnikova LA, Danilova MS, Shabalina AA, Gubanova MV, Shamtieva KV, Dreval MV, Dobrynina LA. [Transforming growth factor beta in patients with cervical artery dissection]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:82-87. [PMID: 36279232 DOI: 10.17116/jnevro202212210182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To evaluate transforming growth factor beta (TGF-β) in patients with cervical artery dissection (CeAD). MATERIAL AND METHODS TGF-β was studied by enzyme immunoassay in 74 of 336 patients with CeAD observed at the Research Center of Neurology (Moscow) from 2000 to 2021. The average patient's age at the time of TGF-β study was 41.6±9.8 years; the proportion of women was 51%. TGF-β was studied in the first month of the disease (n=9), for 2-3 months (n=12) and at a later period (mean - 4.3±5.03 years) (n=53). The control group consisted of 20 healthy volunteers, matched for age and sex. Dissection occurred in internal carotid artery (ICA) (n=42), vertebral artery (VA) (n=29), ICA+VA (n=3) and involved 1 artery (n=58) or 2-3 arteries (n=16). Clinical manifestations included ischemic stroke (IS) (n=49), isolated cervical-cephalic headache (n=23), lower cranial nerve palsy (n=2). Pathological CeAD tortuosity was detected by angiography in 13 patients, and a dissecting aneurysm in 15 patients. RESULTS TGF-β1 and TGF-β2 were elevated in patients with CeAD patients compared with the control: TGF-β1 - 4990 [3950; 7900] pg/ml vs. 3645 [3230; 4250] pg/ml, p=0.001; TGF-β2 - 6120 [4680; 7900] pg/ml vs. 3155 [2605; 4605] pg/ml, p=0.001. The highest TGF-β1 and TGF-β2 levels were noted at 2-3 months of the disease. There was no correlation between the TGF-β level and various clinical and angiographic parameters. CONCLUSION Increased TGF-β level confirms that CeAD patients have connective tissue disorder that underlies the arterial wall weakness. A higher TGF-β level at 2-3 months of CeAD seems to be connected with an active reparative process in arterial wall after dissection. TGF-β can be used as a biomarker of connective tissue dysplasia in patients with CeAD.
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Affiliation(s)
| | | | | | | | | | - M V Dreval
- Research Center of Neurology, Moscow, Russia
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11
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Postpartum Acute Basilar Artery Occlusion Secondary to Vertebral Artery Dissection. Case Report and Literature Review. J Crit Care Med (Targu Mures) 2021; 7:294-301. [PMID: 34934820 PMCID: PMC8647675 DOI: 10.2478/jccm-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/16/2021] [Indexed: 11/21/2022] Open
Abstract
Female patients in the peripartum and postpartum periods have an increased risk of stroke than nonpregnant women. Cerebrovascular complications of pregnancy represent a significant cause of maternal mortality and morbidity and are potentially disabling. Acute basilar artery occlusion secondary to spontaneous vertebral artery dissection in the postpartum period is an infrequent entity and a major diagnostic and treatment challenge. In the present case, a 37-year-old female patient, eight weeks after caesarean delivery, presented with a history of sudden cervical pain, followed by headache and dizziness. Some hours later, she was found unconscious by her family and was transferred to the emergency department, where a neurological status assessment suggested vertebrobasilar stroke. The imagistic workup revealed right vertebral artery dissection and basilar artery occlusion without constituted ischemic lesions. The patient underwent endovascular intervention with dilation of the narrowed vertebral artery and stent retriever basilar artery thrombectomy, with a favourable clinical outcome. This report first presents the details of this case and the relevant literature data on postpartum arterial dissections and the subsequent ischemic complications and available treatment options.
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12
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Kalashnikova LA, Danilova MS, Gubanova MV, Dobrynina LA. [Cervical artery dissection in women: relationships with pregnancy and postpartum period]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:7-12. [PMID: 34874648 DOI: 10.17116/jnevro20211211017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the frequency of CeAD that developed during pregnancy or in post partum period among all CeADs in women; to study the course of pregnancy in women with prior CeAD. MATERIAL AND METHODS 162 women (mean age 37.1±4.1 years) with CeAD we examined at the Research Center of Neurology (Moscow), 98% women were studied during last 15 years. 140 women were of childbearing age (≤45 years, mean age - 35±2.8 years). All patients were interviewed whether or not CeAD occurred during pregnancy or in post partum period (CeADPPP). Obstetric history before and after CeAD was studied in 57 women of childbearing age (average age - 35.9±7.3 years at CeAD development). RESULTS CeADPPP developed in 6 out of 162 all female patients (3.7%) or of 140 childbearing age patients (4.3%). It occurred 2-6 months (4 patients) and 10 days after delivery (1 patient), or on the 25th week of pregnancy (1 patient). CeADPPP patients were younger than patients with CeAD out of pregnancy or postpartum period (29.8±8 years vs 35.1±6.7 years, p>0.05). CeADPPP in comparison with CeAD outside these periods more often involved internal carotid artery (ICA) (50% vs 35%, p=0.666), more often occurred in 2-3 arteries (50% vs 31%, p=0.386) and more often was accompanied by dissecting aneurysm development (50% vs 8%, p=0.013). After CeAD, 18 out of 57 patients in whom obstetric history was studied, including 3 patients with postpartum dissection had 29 pregnancies. The pregnancy outcomes were as follows: childbirth (17 pregnancies, 59%), fetal loss (8 pregnancies, 27%) and medical abortion (4 pregnancies, 14%). Delivery occurred on average 4.5±2.061 years after CeAD in women aged 33.0±4.25 years (cesarean section - 15 patients). Fetal loss occurred at 7.4±3.5 weeks of pregnancy in women aged 37.6±3.13 years on average 2.7±1.4 years after CeAD. Fetal loss frequency after CeAD was higher than before it (27% vs 7%, p=0.016). There were no CeAD recurrences during pregnancy and postpartum period in women who had previously undergone CeAD. CONCLUSION CeADPPP frequency among all dissections in women is 3.7-4.3%. The risk of CeAD recurrence during pregnancy or the postpartum period after prior CeAD is very low. The risk of fetal loss during 2.7±1.4 years after CeAD is higher than before it (27% vs 7%). Hormonal and growth factors associated with pregnancy and the postpartum period is suggested to contribute to cervical artery wall damage. It is possible that the prolonged action of some of these factors may disrupt the placental vessels formation, predisposing to miscarriage.
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13
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Ruan CY, Gao BL, Pang HL, Zhang K, Zhang YH, Wei LP, Li TX, Wang ZL. Postpartum cerebral arterial dissections: Clinical features and treatment. Medicine (Baltimore) 2021; 100:e27798. [PMID: 34964745 PMCID: PMC8615341 DOI: 10.1097/md.0000000000027798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Abstract
Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections.One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed.A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%).Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.
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Affiliation(s)
- Chun-Yun Ruan
- Luoyang Central Hospital, Zhengzhou University, China
| | - Bu-Lang Gao
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Hong-Li Pang
- Luoyang Central Hospital, Zhengzhou University, China
| | - Kun Zhang
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Yao-Hui Zhang
- Luoyang Central Hospital, Zhengzhou University, China
| | - Li-Ping Wei
- Luoyang Central Hospital, Zhengzhou University, China
| | - Tian-Xiao Li
- Henan Provincial People's Hospital, Zhengzhou University, China
| | - Zi-Liang Wang
- Henan Provincial People's Hospital, Zhengzhou University, China
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14
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Bojanowski MW, Stefanovic K, Bergeron D, Farzin B, Létourneau-Guillon L, Chaalala C. Pregnancy as a Subgroup in the Pathophysiologic Classification of Spinal Aneurysms. World Neurosurg 2021; 157:e264-e270. [PMID: 34637940 DOI: 10.1016/j.wneu.2021.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aneurysms of spinal arteries not associated with any known predisposing condition are referred to as isolated spinal aneurysms (SAs). In our series, an SA was found in 2 patients during the postpartum period. The goal of this study is to determine whether an occurrence of an SA may be related to puerperium. METHODS In a retrospective analysis of our consecutive series of 10 cases of SAs from 2008 to 2020, we identified 2 cases of SAs during puerperium. Patients' charts and imaging were reviewed, for potential predisposing factors. RESULTS In both cases, angiography showed fusiform aneurysms of the anterior SA with concomitant bilateral vertebral artery (VA) dissections. Serum vasculitis and inflammatory panel and genetic testing for collagen disorders were negative in both cases. Review of the literature showed that pregnancy is associated with an increased risk of arterial dissections in various locations and supports the hypothesis that hemodynamic and hormonal changes may play a role in the formation of SAs. CONCLUSIONS Pregnancy and peripartum state may be a distinct cause of the formation of SAs, possibly as a result of increased hemodynamic stress and hormonal changes that may alter the arterial wall. It would be appropriate to add pregnancy as a subgroup in the classification of SAs. In our series, both cases were associated with bilateral VA dissections; it is possible that the bilateral VA stenosis may have contributed to the formation of the SAs. It is important to recognize this possibility when considering the occlusion of a dissected VA.
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Affiliation(s)
| | | | - David Bergeron
- Division of Neurosurgery, University of Montreal, Montreal, Canada
| | - Behzad Farzin
- Department of Radiology, University of Montreal, Montreal, Canada
| | | | - Chiraz Chaalala
- Division of Neurosurgery, University of Montreal, Montreal, Canada
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15
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Azad HA, Prasad N, Shlobin NA, Mitra A, Cloney MB, Hopkins BS, Jahromi BS, Potts MB, Dahdaleh NS. Clinical Characteristics, Course, and Outcomes of Vertebral Artery Dissections in the Postpartum Period. Neurosurgery 2021; 89:792-799. [PMID: 34383947 DOI: 10.1093/neuros/nyab296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Postpartum vertebral artery dissections (ppVADs) are rare but potentially morbid conditions that occur in otherwise healthy patients. OBJECTIVE To evaluate clinical characteristics of ppVADs. METHODS Demographic, clinical, treatment, and outcome data were collected on ppVADs and are presented in a case series of 12 patients and compared to the general cohort. RESULTS In total, 12 patients had ppVADs in our cohort of 310 patients with vertebral artery dissections (VADs). They occurred 11.27 days (95% CI, -0.85 to 23.39) postdelivery. Of these, there were 5 (42%) with a hypertensive disorder of pregnancy, and 4 (33%) who had migraines. A total of 3 (25%) had ischemic strokes and 1 (8%) had a subarachnoid hemorrhage. In total, 2 patients (17%) had unfavorable modified Rankin Scale (mRS, 2-6) at discharge from hospital. Patients with ppVADs more often had bilateral VADs (42% vs 17%, P = .03), had pseudoaneurysms (50% vs 18%, P = .0068), were younger (33.83 years vs 44.32 years, P = .018), and had lower Charlson Comorbidity Index (CCI = 0 vs 0.99, P = .0038). Anticoagulant treatment was used in a similar percentage of patients. Multivariate analysis revealed 3 factors were predictive of change in mRS: CCI (OR = 1.09, 95% CI, 1.02-1.15), stroke (OR = 0.78, 95% CI, 0.65-0.95), and mRS at hospital discharge (OR = 0.80, 95% CI, 0.74-0.87). CONCLUSION There are only 15 isolated ppVADs reported in the literature; this study adds 12 patients with 17 ppVADs. Postpartum VADs occur in younger, healthier patients than in the general cohort, raising questions about mechanism of injury. The majority of ppVADs have good neurological outcomes.
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Affiliation(s)
- Hooman A Azad
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nikil Prasad
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nathan A Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Akash Mitra
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael B Cloney
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Benjamin S Hopkins
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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16
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Beyer SE, Dicks AB, Shainker SA, Feinberg L, Schermerhorn ML, Secemsky EA, Carroll BJ. Pregnancy-associated arterial dissections: a nationwide cohort study. Eur Heart J 2021; 41:4234-4242. [PMID: 32728725 DOI: 10.1093/eurheartj/ehaa497] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/08/2020] [Accepted: 05/28/2020] [Indexed: 12/27/2022] Open
Abstract
AIMS Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. METHODS AND RESULTS We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151 897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. <0.001% in patients without a dissection. Deaths were isolated to patients with an aortic (8.6%), coronary (4.2%), or supra-aortic (<2.5%) dissection. CONCLUSION Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions.
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Affiliation(s)
- Sebastian E Beyer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Andrew B Dicks
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Loryn Feinberg
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Eric A Secemsky
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA.,Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
| | - Brett J Carroll
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 4, Boston, MA 02215, USA
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17
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KADOOKA K, SUEMITSU T, SAITO H, KADOOKA M, MITSUTAKE T, TANAKA M. Intrapartum Subarachnoid Hemorrhage from Suspected Lateral Posterior Choroidal Artery Dissection. NMC Case Rep J 2021; 8:625-630. [PMID: 35079526 PMCID: PMC8769464 DOI: 10.2176/nmccrj.cr.2020-0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/13/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Keisuke KADOOKA
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Tokumasa SUEMITSU
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hiroshi SAITO
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Mizuho KADOOKA
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Takafumi MITSUTAKE
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Michihiro TANAKA
- Department of Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
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18
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Nehme A, Létourneau-Guillon L, Odier C, Poppe AY. Clinical Reasoning: A 36-Year-Old Woman Presenting With Headache Postpartum. Neurology 2020; 96:e1585-e1589. [PMID: 33277423 DOI: 10.1212/wnl.0000000000011318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ahmad Nehme
- From Neurologie Vasculaire (A.N., C.O., A.Y.P.) and Radiologie (L.L.-G.), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal; and Axe Neurosciences (C.O., A.Y.P.), Centre de Recherche du CHUM, Montréal, Canada.
| | - Laurent Létourneau-Guillon
- From Neurologie Vasculaire (A.N., C.O., A.Y.P.) and Radiologie (L.L.-G.), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal; and Axe Neurosciences (C.O., A.Y.P.), Centre de Recherche du CHUM, Montréal, Canada
| | - Céline Odier
- From Neurologie Vasculaire (A.N., C.O., A.Y.P.) and Radiologie (L.L.-G.), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal; and Axe Neurosciences (C.O., A.Y.P.), Centre de Recherche du CHUM, Montréal, Canada
| | - Alexandre Y Poppe
- From Neurologie Vasculaire (A.N., C.O., A.Y.P.) and Radiologie (L.L.-G.), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal; and Axe Neurosciences (C.O., A.Y.P.), Centre de Recherche du CHUM, Montréal, Canada
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19
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Manasewitsch NT, Hanfy AA, Beutler BD, Antwi-Amoabeng D, Taha M, Elnaggar M, Chahal GS. Postpartum vertebral artery dissection: case report and review of the literature. Thromb J 2020; 18:30. [PMID: 33292273 PMCID: PMC7597033 DOI: 10.1186/s12959-020-00243-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy are associated with vascular complications, including ischemic stroke and cervical artery dissection. Vertebral artery dissection (VAD), however, is rare. We describe a 31-year-old female who presented with vertigo, nausea, and vomiting and was found to have a VAD. In addition, we discuss the presentation, differential diagnosis, and pathogenesis of this uncommon but clinically significant vascular event and summarize other cases of vertebral artery dissection described in the medical literature. CASE PRESENTATION A 31-year-old Hispanic woman presented 10 days postpartum with a one-day history of vertigo, nausea, vomiting, and frontal headache. The patient's pregnancy course had been complicated by preeclampsia, chorioamnionitis, and iron-deficiency anemia, and her delivery was complicated by acute hemorrhage. Physical examination was significant for left leg ataxia. Laboratory studies showed marked thrombocytosis. Emergent computed tomography (CT) scan of the head was obtained and revealed a left cerebellar ischemic large vessel stroke. Subsequent CT angiography of the head and neck showed a left VAD. Based on correlation of the clinical history and laboratory and imaging findings, a diagnosis of vertebral artery dissection secondary to reactive (secondary) thrombocytosis from overlapping iron-deficiency anemia and acute hemorrhage was established. The patient was started on a heparin infusion and experienced significant improvement after a four-day hospitalization. CONCLUSION VAD is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women aged 30 years or older and those with a history of a hypertensive disorder of pregnancy are at particularly high risk. Prompt diagnosis and management of VAD is essential to ensure favorable outcomes.
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Affiliation(s)
- Nicholas T Manasewitsch
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA
| | - Ahmed A Hanfy
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA
| | - Bryce D Beutler
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA.
| | - Daniel Antwi-Amoabeng
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA
| | - Moutaz Taha
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA
| | - Mohamed Elnaggar
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA
| | - Gurpreet S Chahal
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, 1155 Mill Street, W-11, Reno, NV, 89052, USA
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20
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Salehi Omran S, Parikh NS, Poisson S, Armstrong J, Merkler AE, Prabhu M, Navi BB, Riley LE, Fink ME, Kamel H. Association between Pregnancy and Cervical Artery Dissection. Ann Neurol 2020; 88:596-602. [PMID: 32525238 PMCID: PMC10001425 DOI: 10.1002/ana.25813] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We wanted to determine whether pregnancy is associated with cervical artery dissection. METHODS We performed a case-control study using claims data from all nonfederal emergency departments and acute care hospitals in New York and Florida between 2005 and 2015. Cases were women 12-42 years of age hospitalized with cervical artery dissection, defined using validated diagnosis codes for carotid/vertebral artery dissection. Controls were women 12-42 years of age with a primary diagnosis of renal colic. Cases and controls were matched 1:1 on age, race, insurance, income, state, and visit year. The exposure variable was pregnancy, defined as labor and delivery within 90 days before or 6 months after the index visit. Logistic regression was used to compare the odds of pregnancy between cases and controls. We performed a secondary cohort-crossover study comparing the risk of cervical artery dissection during pregnancy versus the same time period 1 year later. RESULTS Pregnancy was twice as common among 826 women with cervical artery dissection compared with the 826 matched controls with renal colic (odds ratio, 2.5; 95% confidence interval [CI], 1.3-4.7). In our secondary analysis, pregnancy was associated with a higher risk of cervical artery dissection (incidence rate ratio [IRR], 2.2; 95% CI, 1.3-3.5), with the heightened risk limited to the postpartum period (IRR, 5.5; 95% CI, 2.6-11.7). INTERPRETATION Pregnancy, specifically the postpartum period, was associated with hospitalization for cervical artery dissection. Although these findings might in part reflect ascertainment bias, our results suggest that arterial dissection is one mechanism by which pregnancy can lead to stroke. ANN NEUROL 2020;88:596-602.
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Affiliation(s)
- Setareh Salehi Omran
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.,Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Sharon Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer Armstrong
- Department of Pediatrics (Neurology) and Obstetrics and Gynecology, University of Colorado Anschutz School of Medicine & Children's Hospital Colorado, Denver, CO, USA
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Matthew E Fink
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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21
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Kozberg MG, Camargo EC. Management of Maternal Stroke and Mitigating Risk. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:72. [DOI: 10.1007/s11936-019-0770-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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22
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Gao G, Zucconi RL, Zucconi WB. Emergent Neuroimaging During Pregnancy and the Postpartum Period. Neuroimaging Clin N Am 2018; 28:419-433. [DOI: 10.1016/j.nic.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
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Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
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24
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Seizures in the peripartum period: Epidemiology, diagnosis and management. Anaesth Crit Care Pain Med 2016; 35 Suppl 1:S13-S21. [DOI: 10.1016/j.accpm.2016.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Edlow AG, Edlow BL, Edlow JA. Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women. Emerg Med Clin North Am 2016; 34:943-965. [PMID: 27741996 DOI: 10.1016/j.emc.2016.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute neurologic symptoms in pregnant and postpartum women may be caused by exacerbation of a preexisting neurologic condition, the initial presentation of a non-pregnancy-related problem, or a new neurologic problem. Pregnant and postpartum patients with headache and neurologic symptoms are often diagnosed with preeclampsia or eclampsia; however, other etiologies must also be considered. A team approach with close communication between emergency physicians, neurologists, maternal-fetal medicine specialists, and radiologists is the key to obtaining best outcomes. This article reviews the clinical features and differential diagnosis of acute serious neurologic conditions in pregnancy and the puerperium, focusing on diagnosis.
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Affiliation(s)
- Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mother Infant Research Institute, Tufts Medical Center, 800 Washington Street, Box 394, Boston, MA 02111, USA
| | - Brian L Edlow
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA 02114, USA
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Place, West Clinical Center, 2nd Floor, Boston, MA 02215, USA.
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Shanmugalingam R, Reza Pour N, Chuah SC, Vo TM, Beran R, Hennessy A, Makris A. Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review. BMC Pregnancy Childbirth 2016; 16:164. [PMID: 27422677 PMCID: PMC4947248 DOI: 10.1186/s12884-016-0953-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 07/09/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected. CASE PRESENTATION We present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it. CONCLUSION Our case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP.
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Affiliation(s)
- Renuka Shanmugalingam
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
- Western Sydney University, Penrith, Australia
- Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney Australia
| | - Nina Reza Pour
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Siang Chye Chuah
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Thi Mong Vo
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Roy Beran
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
| | - Annemarie Hennessy
- Campbelltown Hospital, Therry Road, Campbelltown, 2560 NSW Australia
- Western Sydney University, Penrith, Australia
- Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney Australia
| | - Angela Makris
- Liverpool Hospital, Elizabeth Street, Liverpool, 2170 NSW Australia
- Western Sydney University, Penrith, Australia
- University of New South Wales, Sydney, Australia
- Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney Australia
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Topcuoglu MA, Kursun O, Singhal AB. Coexisting vascular lesions in reversible cerebral vasoconstriction syndrome. Cephalalgia 2016; 37:29-35. [DOI: 10.1177/0333102416637826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The pathophysiology of reversible cerebral vasoconstriction syndrome (RCVS) is not known. Published cases have documented coexisting cervical artery dissection and unruptured aneurysms, raising the possibility that ultrastructural vessel wall abnormalities underlie the development of vascular lesions as well as RCVS. Methods In this retrospective study we compared the frequency of neurovascular abnormalities in 158 consecutive RCVS patients, 44 patients with primary angiitis of the central nervous system (PACNS, positive controls), and 177 non-stroke patients with acute neurological symptoms (non-arteriopathy controls). Results Coexisting neurovascular abnormalities were significantly higher ( p < 0.001) in RCVS (23%) as compared to the PACNS (5%) or non-arteriopathy groups (8%). Cervical artery dissections were noted only in the RCVS group (8%, p < 0.001). The RCVS group had more unruptured aneurysms than PACNS (13% vs. 5%, p = 0.099) or non-arteriopathy controls (13% vs. 7%, p = 0.05). Seven RCVS patients also had other vascular malformations (venous anomaly, cavernous malformations, fibromuscular dysplasia). There was no significant association between coexisting vascular abnormalities and brain lesions or discharge clinical outcome in the RCVS group. Conclusion The high prevalence and heterogeneous anatomy of coexisting vascular lesions suggest that subtle ultrastructural arterial wall abnormalities may contribute to their development and also predispose to RCVS.
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Affiliation(s)
- M Akif Topcuoglu
- Department of Neurology, Massachusetts General Hospital, USA
- Department of Neurology, Hacettepe University Hospitals, Turkey
| | - Oguzhan Kursun
- Department of Neurology, Massachusetts General Hospital, USA
- Neurology Clinics, Ankara Numune Education and Research Hospital, Turkey
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Santos L, Azevedo E. Reversible cerebral vasoconstriction syndrome - A narrative revision of the literature. Porto Biomed J 2016; 1:65-71. [PMID: 32258552 DOI: 10.1016/j.pbj.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/18/2015] [Indexed: 12/18/2022] Open
Abstract
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a not very well known clinical-imaging entity; it is characterized by thunderclap headache, which mimics an aneurysmal subarachnoid haemorrhage, and a diffuse and segmental constriction of cerebral arteries, that resolves spontaneously within 3 months. The pathophysiology remains unknown. The female gender is the more affected and more than half of cases occur in the puerperium or after exposure to vasoactive substances. Typically, RCVS is self-limited and has a benign course, although it may have more serious complications with permanent neurologic sequelae and death. Treatment is predominantly supportive and directed to the symptoms.
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Affiliation(s)
- Laura Santos
- Department of Neurology and Neurosurgery, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology and Neurosurgery, Faculty of Medicine of University of Porto, Porto, Portugal
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Mawet J, Debette S, Bousser MG, Ducros A. The Link Between Migraine, Reversible Cerebral Vasoconstriction Syndrome and Cervical Artery Dissection. Headache 2016; 56:645-56. [PMID: 27016026 DOI: 10.1111/head.12798] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Headache is the common thread of migraine, reversible cerebral vasoconstriction syndrome (RCVS) and cervical artery dissection (CeAD), three medical conditions that otherwise appear to be very different. However, epidemiological, clinical and genetic data suggest that these conditions share common and complex features and are, at least partly, linked. The purpose of this manuscript is to review existing evidence for an association between migraine, RCVS and CeAD and discuss the potential underlying mechanisms.
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Affiliation(s)
- Jérôme Mawet
- Emergency Headache Center, Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (J. Mawet)
| | - Stéphanie Debette
- Institut National de la Santé et de la Recherche Médicale (INSERM) U897 Epidemiology and Biostatistics and Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S. Debette)
| | - Marie-Germaine Bousser
- Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (M.-G. Bousser)
| | - Anne Ducros
- Department of Neurology, Montpellier University Hospital and Montpellier University, Montpellier, France (A. Ducros)
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Garrard JW, Simm RF, Bor-Seng-Shu E, Nogueira RC. Puerperal Extracranial Vertebral Artery Dissection and Nonaneurysmal Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2016; 25:e12-4. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/27/2015] [Accepted: 10/06/2015] [Indexed: 11/24/2022] Open
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Singhal AB. Reversible Cerebral Vasoconstriction Syndromes. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Finley A, Rogers B, Richards T, Vogel H. Postpartum vertebral artery dissection. BMJ Case Rep 2015; 2015:bcr-2015-211872. [PMID: 26604230 DOI: 10.1136/bcr-2015-211872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a right vertebral artery dissection in a 35-year-old woman, 3 weeks post partum, with manifestations of vertebrobasilar disease. She was 3 weeks out from the uneventful delivery of her fourth child, with presentation of acute neurological symptoms, predominantly intractable vertigo. Vertigo can have many non-specific generalised symptoms and clinical findings. Postpartum women have a lengthy list of possible aetiologies of vertigo not limited to our initially suspected preeclampsia, dural venous thrombosis and vertebral dissection.
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Affiliation(s)
- Amanda Finley
- Magnolia Regional Health Center, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Brenton Rogers
- Department of Graduate Medical Education, Magnolia Regional Health Center, Corinth, Mississippi, USA
| | - Theodore Richards
- Department of Graduate Medical Education, Magnolia Regional Health Center, Corinth, Mississippi, USA
| | - Heather Vogel
- Department of Graduate Medical Education, Magnolia Regional Health Center, Corinth, Mississippi, USA
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Nishimura M, Hiraoka E, Kanazawa K, Akita H. Postpartum vertebral artery dissection with posterior reversible encephalopathy syndrome. BMJ Case Rep 2015; 2015:bcr-2014-207332. [PMID: 26150612 DOI: 10.1136/bcr-2014-207332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We diagnosed postpartum eclampsia with posterior reversible encephalopathy syndrome (PRES) in a 35-year-old woman who began experiencing headaches after delivery. Cervical MR angiography (MRA) suggested concomitant vertebral artery (VA) dissection. Antiplatelet therapy was not indicated. Each episode resolved spontaneously. The patient subsequently developed sudden onset of thunderclap headache. She experienced a tonicoclonic seizure in the outpatient clinic. On the basis of clinical course and MRI, we diagnosed postpartum eclampsia with PRES. Antiplatelet therapy was not indicated, as there were no signs of stroke. Antiepileptic and antihypertensive medicines were used for a short term to control seizure and blood pressure. Subsequent MRI 17 days after discharge showed resolution of the abnormal signals, but the intramural heme signals became apparent on the dissecting segment of VA. Subsequent MRI after 3 months indicated resolution of arterial dissection. To the best of our knowledge, this represents the third report of postpartum cervicocephalic artery dissection with PRES in the literature.
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Affiliation(s)
- Mitsushige Nishimura
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Eiji Hiraoka
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Kenji Kanazawa
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Hozuka Akita
- Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan
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Skeik N, Porten BR, Kadkhodayan Y, McDonald W, Lahham F. Postpartum reversible cerebral vasoconstriction syndrome: Review and analysis of the current data. Vasc Med 2015; 20:256-65. [DOI: 10.1177/1358863x14567976] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postpartum reversible cerebral vasoconstriction syndrome (PPRCVS) is a rare but serious cause of headache that occurs in the early postpartum period. The rarity of this disorder has limited the current literature to single case reports and small, observational case series. The lack of familiarity with PPRCVS may contribute to mismanagement of these unique patients and lead to poor outcomes. To address current gaps in the understanding of PPRCVS, this review and data analysis characterizes the demographics, presentation, clinical course, management and prognosis of PPRCVS and provides a general review of the epidemiology, pathophysiology and diagnosis to assist clinicians who may care for patients with this rare disorder.
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Yasha Kadkhodayan
- Department of Pathology, Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Firas Lahham
- Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA
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36
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Spontaneous dissection of the bilateral internal carotid and vertebral arteries: A rationale for endovascular management. J Neurol Sci 2015; 350:112-4. [DOI: 10.1016/j.jns.2015.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/15/2015] [Accepted: 02/02/2015] [Indexed: 11/22/2022]
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Straube A, Klein M, Erbguth F, Maschke M, Klawe C, Sander D, Hilz MJ, Ziemssen T, Klucken J, Kohl Z, Winkler J, Bettendorf M, Staykov D, Berrouschot J, Dörfler A. Metabolische Störungen. NEUROINTENSIV 2015. [PMCID: PMC7175475 DOI: 10.1007/978-3-662-46500-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Im folgenden Kapitel werden die verschiedenen metabolischen Störungen betrachtet. Zunächst wird auf die allgemeinen und spezifischen neurologischen Komplikationen bei Organtransplantation eingegangen. Dann geht es um die metabolischen Enzephalopathien: Störungen der Gehirntätigkeit bei angeborenen und erworbenen Stoffwechselerkrankungen im engeren Sinn, Elektrolytstörungen, Hypovitaminosen, zerebrale Folgen einzelner Organdysfunktionen, zerebrale Hypoxien, Endotheliopathien und Mitochondropathien. Anschließend werden das Alkoholdelir und die Wernicke-Enzephalopathie erörtert. Bei zahlreichen akuten Erkrankungen von Gehirn, Rückenmark und peripherem Nervensystem treten typische Störungen vegetativer Systeme auf, deren Erkennung und Therapie insbesondere bei Intensivpatienten eine vitale Bedeutung haben kann: die autonomen Störungen. Bei der zentralen pontinen Myelinolyse kommt es zu einer akuten, vorwiegend fokal-symmetrischen Demyelinisierung im Hirnparenchym. Auch Basalganglienerkrankungen können intensivmedizinisch relevant werden. Und schließlich wird die akute Stressreaktion betrachtet, die aufgrund der vielfältigen metabolischen und endokrinen Veränderungen bei kritischen Erkrankungen entsteht. Gerade das RCVS als neuere Krankheitsentität und wichtige Differenzialdiagnose zur Vaskulitis des ZNS verdient einen eigenen Platz, in diesem Unterkapitel werden ebenfalls verwandte Syndrome wie die hypertensive Enzephalopathie und das PRES abgehandelt.
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Reinhard M, Munz M, von Kannen AL, Griesser-Leute HJ, Dittrich R, Engelter ST. Risk of recurrent cervical artery dissection during pregnancy, childbirth and puerperium. Eur J Neurol 2014; 22:736-9. [DOI: 10.1111/ene.12602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/24/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Reinhard
- Department of Neurology; University of Freiburg; Freiburg Germany
| | - M. Munz
- Department of Neurology; University of Freiburg; Freiburg Germany
| | - A.-L. von Kannen
- Department of Neurology; University of Freiburg; Freiburg Germany
| | | | - R. Dittrich
- Department of Neurology; University of Münster; Münster Germany
| | - S. T. Engelter
- Department of Neurology and Stroke Center; University of Basel; Basel Switzerland
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Mehdi A, Hajj-Ali RA. Reversible Cerebral Vasoconstriction Syndrome: a Comprehensive Update. Curr Pain Headache Rep 2014; 18:443. [DOI: 10.1007/s11916-014-0443-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Devenney E, Neale H, Forbes RB. A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based? J Headache Pain 2014; 15:49. [PMID: 25123846 PMCID: PMC4231167 DOI: 10.1186/1129-2377-15-49] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 06/03/2014] [Indexed: 02/07/2023] Open
Abstract
Background There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review. Methods Systematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes. Results Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes. Conclusions There are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral vasoconstriction syndromes.
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Affiliation(s)
| | | | - Raeburn B Forbes
- Department of Neurology and Medical Library, Craigavon Area Hospital, Southern HSC Trust, County Armagh, Northern Ireland BT63 5QQ, UK.
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Aronov M, Shevchenko NS, Amosova NA, Kotenko KV. Acute three-vessel cervical arterial occlusion due to spontaneous quadruple cervical artery dissection. BMJ Case Rep 2014; 2014:bcr-2014-203725. [PMID: 24957585 DOI: 10.1136/bcr-2014-203725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cervical artery dissection (CAD) is one of the most frequent causes (14.5%) of stroke in young adults. Cases with involvement of more than two arteries are rare. Arnold et al described 11 cases (1.5%) with triple CAD of a reported 740 patients and just a single (0.1%) quadruple case in the same population. Simultaneous dissection of the four principal vessels is extremely rare. According to Papagiannaki et al, the incidence of simultaneous three or four CADs is 1-3/million in the general population. To the best of our knowledge, there are only three published cases of spontaneous quadruple CAD.
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Affiliation(s)
- Moisey Aronov
- Department of Endovascular, State Research Center Burnasyan FMBC of the FMBA of Russia, Moscow, Russian Federation
| | - Natalia S Shevchenko
- Department of Vascular Neurology, State Research Center Burnasyan FMBC of the FMBA of Russia, Moscow, Russian Federation
| | - Natalia A Amosova
- Department of Administration, State Research Center Burnasyan FMBC of the FMBA of Russia, Moscow, Russian Federation
| | - Konstantin V Kotenko
- Department of Administration, State Research Center Burnasyan FMBC of the FMBA of Russia, Moscow, Russian Federation
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Chtaou N, Messouak O, Belahsen MF. [Ischemic stroke secondary to spontaneous arterial dissection of the internal carotid artery: a rare postpartum complication]. ACTA ACUST UNITED AC 2014; 39:282-4. [PMID: 24908416 DOI: 10.1016/j.jmv.2014.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
We report a case of ischemic stroke caused by internal carotid artery dissection in a 35-year-old woman in postpartum following spontaneous labor and vaginal delivery. Ischemic stroke due to arterial dissection requires rapid diagnosis and anticoagulation.
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Affiliation(s)
- N Chtaou
- Service de neurologie, CHU Hassan II, km 2,200, route Sidi Hrazem, BP 30000, Fès, Maroc.
| | - O Messouak
- Service de neurologie, CHU Hassan II, km 2,200, route Sidi Hrazem, BP 30000, Fès, Maroc
| | - M F Belahsen
- Service de neurologie, CHU Hassan II, km 2,200, route Sidi Hrazem, BP 30000, Fès, Maroc
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45
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Nouh A, Ruland S, Schneck MJ, Pasquale D, Biller J. Reversible Cerebral Vasoconstriction Syndrome with Multivessel Cervical Artery Dissections and a Double Aortic Arch. J Stroke Cerebrovasc Dis 2014; 23:e141-3. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/24/2022] Open
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46
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Tang SC, Jeng JS. Management of stroke in pregnancy and the puerperium. Expert Rev Neurother 2014; 10:205-15. [DOI: 10.1586/ern.09.126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Reversible cerebral vasoconstriction syndrome is characterized by severe headaches with or without focal neurologic deficits and/or seizures, and segmental constriction of cerebral arteries that resolves within 3 months. This increasingly recognized syndrome is supposedly due to a transient disturbance in the control of cerebral vascular tone with sympathetic overactivity. It can cause stroke in the young. It affects mainly middle-aged women. More than half the cases occur after exposure to vasoactive substances or during postpartum. The manifestations have a monophasic course, without new clinical symptom after 4 weeks, and range from pure cephalalgic forms with recurrent thunderclap headaches over 1-2 weeks to rare catastrophic forms with multiple hemorrhagic and ischemic strokes, brain edema and death. Diagnosis may be hampered by the dynamic nature of clinicoradiological features. Convexity subarachnoid hemorrhage or stroke may occur a few days after initial normal imaging, and cerebral vasoconstriction is maximal on angiography 2-3 weeks after clinical onset. Symptomatic treatment includes rest and removal of vasoactive substances. Nimodipine has been proposed to reduce thunderclap headaches within 48 hours, but has no proven effect on the hemorrhagic and ischemic complications.
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Affiliation(s)
- Anne Ducros
- Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France.
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Abstract
A postpartum four-vessel cervical artery dissection with no stroke is reported. This transient vasculopathy took place in the autoimmune context of the HELLP syndrome combined with the reversible posterior leucoencephalopathy syndrome. Correlations between the clinical, radiological and biological entities are discussed.
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Affiliation(s)
- Bruno Barroso
- Stroke Unit, Department of Neurology, F. Mitterrand Hospital, Pau, France
| | - Stéphanie Demasles
- Stroke Unit, Department of Neurology, F. Mitterrand Hospital, Pau, France
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50
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von Babo M, De Marchis GM, Sarikaya H, Stapf C, Buffon F, Fischer U, Heldner MR, Gralla J, Jung S, Simonetti BG, Mattle HP, Baumgartner RW, Bousser MG, Arnold M. Differences and Similarities Between Spontaneous Dissections of the Internal Carotid Artery and the Vertebral Artery. Stroke 2013; 44:1537-42. [DOI: 10.1161/strokeaha.113.001057] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Michelle von Babo
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Gian Marco De Marchis
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Hakan Sarikaya
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Christian Stapf
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Fréderique Buffon
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Urs Fischer
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Mirjam R. Heldner
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Jan Gralla
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Simon Jung
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Barbara Goeggel Simonetti
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Heinrich P. Mattle
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Ralf W. Baumgartner
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Marie-Germaine Bousser
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
| | - Marcel Arnold
- From the Department of Neurology (M.v.B., G.M.D.M., H.S., U.F., M.R.H., S.J., B.G.S., H.P.M., M.A.) and Neuroradiology (J.G.), University Hospital of Bern, Bern¸ Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland (H.S., R.W.B.); and Department of Neurology, Hôpital Lariboisière, APHP, Université Paris-Diderot, Paris, France (C.S., F.B., M.-G.B.)
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