TAKE-HOME MESSAGE

• In patients with cervical artery dissection, 25% developed new ischemic brain lesions regardless of the type of antithrombotic treatment.
• There is a 25% recurrent stroke rate for patients who have suffered stroke from previous cervical artery dissection.
• Since chiropractors are often accused of causing dissections, it is proper for chiropractic physicians to educate their patients about the real cause of cervical artery disections and for them to be on guard for patients suffering stroke symptoms on presentation.

Abstract

BACKGROUND AND PURPOSE

To determine the frequency of new ischaemic or hemorrhagic brain lesions on early follow-up magnetic resonance imaging (MRI) in patients with cervical artery dissection (CAD) and to investigate the relationship with antithrombotic treatment.

METHODS

This prospective observational study included consecutive CAD patients with ischaemic or non-ischaemic symptoms within the preceding 4 weeks. All patients had baseline brain MRI scans at the time of CAD diagnosis and follow-up MRI scans within 30 days thereafter. Ischaemic lesions were detected by diffusion-weighted imaging (DWI), intracerebral bleeds (ICBs) by paramagnetic-susceptible sequences. Outcome measures were any new DWI lesions or ICBs on follow-up MRI scans. Kaplan-Meier statistics and calculated odds ratios with 95% confidence intervals were used for lesion occurrence, baseline characteristics and type of antithrombotic treatment (antiplatelet versus anticoagulant).

RESULTS

Sixty-eight of 74 (92%) CAD patients were eligible for analysis. Median (interquartile range) time interval between baseline and follow-up MRI scans was 5 (3-10) days. New DWI lesions occurred in 17 (25%) patients with a cumulative 30-day incidence of 41.3% (standard error 8.6%). Occurrence of new DWI lesions was associated with stroke or transient ischaemic attack at presentation [7.86 (2.01-30.93)], occlusion of the dissected vessel [4.09 (1.24-13.55)] and presence of DWI lesions on baseline MRI [6.67 (1.70-26.13)]. The type of antithrombotic treatment had no impact either on occurrence of new DWI lesions [1.00 (0.32-3.15)] or on functional 6-month outcome [1.27 (0.41-3.94)]. No new ICBs were observed.

CONCLUSION

New ischaemic brain lesions occurred in a quarter of CAD patients, independently of the type of antithrombotic treatment. MRI findings could potentially serve as surrogate outcomes in pilot treatment trials.

Citation

Eur. J. Neurol. 2015 May 01;22(5)859-e61, H Gensicke, F Ahlhelm, S Jung, A von Hessling, C Traenka, B Goeggel Simonetti, N Peters, LH Bonati, U Fischer, A Broeg-Morvay, DJ Seiffge, J Gralla, C Stippich, RW Baumgartner, PA Lyrer, M Arnold, ST Engelter. New Ischaemic Brain Lesions in Cervical Artery Dissection Stratified to Antiplatelets or Anticoagulants. Article first published online: 24 FEB 2015. DOI: 10.1111/ene.12682

Click to view abstract.

 http://onlinelibrary.wiley.com/doi/10.1111/ene.12682/abstract