Cervicocerebral Artery Dissection
Cervicocerebral artery dissection is a condition in which blood seeps between the wall layers of the neck and brain arteries (carotid or vertebral artery), causing narrowing or occlusion of the vessel. It is an important cause of stroke in young and middle-aged adults.
最后更新: 2026-06-07
Definition
Arterial dissection develops when there is a tear between the wall layers of the internal carotid or vertebral artery, with blood collecting within the wall (intramural hematoma). This collection narrows or occludes the vessel lumen and may form a bulge in the wall (pseudoaneurysm). It accounts for a significant proportion of ischemic strokes in young and middle-aged adults and is an important vascular emergency.
Causes and Risk Factors
Dissection may follow mechanical forces such as head-neck trauma, sudden neck rotation/extension or neck manipulation, or it may arise spontaneously. In spontaneous cases an underlying vessel-wall disorder weakening the artery (for example fibromuscular dysplasia, Ehlers-Danlos or Marfan syndrome) may be present. Minor strains such as coughing, vomiting or certain sporting movements can also trigger it. Hypertension and migraine are additional risk factors.
Symptoms
Carotid dissection may cause sudden one-sided neck, jaw or facial pain, drooping of the eyelid and pupil constriction on the same side (Horner syndrome), and pulsatile tinnitus. Vertebral artery dissection may cause occipital/neck pain, dizziness, double vision, imbalance and swallowing difficulty. A transient ischemic attack or stroke can develop within hours to days after dissection, so early diagnosis is important.
Diagnosis
First-line imaging is fast, non-invasive CT angiography or MR angiography. Fat-suppressed T1 MRI sequences show the intramural hematoma in the vessel wall. Typical findings include long-segment narrowing, a flame-shaped taper and a double-lumen appearance. Digital subtraction angiography (DSA) is the gold standard but, being invasive, is generally reserved for cases where the diagnosis is unclear or endovascular treatment is planned.
Treatment
The aim of treatment is to prevent clot-related (thromboembolic) stroke. The first-line approach is antithrombotic therapy; studies have shown anticoagulant and antiplatelet therapy to be of similar effectiveness. Treatment is usually continued for several months, then maintained with an antiplatelet agent. Endovascular treatment (stent/balloon) or, rarely, surgery is considered in selected situations such as progressive narrowing unresponsive to conservative therapy, recurrent embolism or inadequate brain blood flow.
Prognosis
The large majority of dissections heal spontaneously within a few months (recanalization of the vessel and resorption of the intramural blood). The highest stroke risk is in the first days and weeks; early antithrombotic therapy reduces this risk. During recovery, avoidance of straining neck movements and contact sports is advised. The recurrence risk is generally low but increases when an underlying vessel-wall disorder is present. Outcomes differ by patient and cannot be guaranteed.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1579-1581.
- Markus HS, et al. Antiplatelet versus Anticoagulation in Cervical Artery Dissection (CADISS). Lancet Neurol. 2015.
- Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。