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Traumatic Intracranial Arterial Dissection
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Traumatic dissection and pseudoaneurysm
          • Definitions

            • Dissection: Intramural hematoma extends along vessel wall
            • Intimal extension
              • Intimal flap
              • True and false lumen
            • Arterial transection
              • Extension through adventitia
            • Dissecting aneurysm: Aneurysmal dilation of vessel due to dissection, contained only by adventitia
              • Hematoma between media/adventitia common
            • Pseudoaneurysm: Lumen contained only by thrombus outside vessel wall

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Angiographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Kansagra AP et al: Current trends in endovascular management of traumatic cerebrovascular injury. J Neurointerv Surg. 6(1):47-50, 2014
                                    2. Prasad V et al: Pipeline endovascular reconstruction of traumatic dissecting aneurysms of the intracranial internal carotid artery. J Neurointerv Surg. 6(10):e48, 2014
                                    3. Ro A et al: Pathomorphological differentiation between traumatic rupture and nontraumatic arterial dissection of the intracranial vertebral artery. Leg Med (Tokyo). 16(3):121-7, 2014
                                    4. Rahme RJ et al: Spontaneous cervical and cerebral arterial dissections: diagnosis and management. Neuroimaging Clin N Am. 23(4):661-71, 2013
                                    5. Cohen JE et al: Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections. J Trauma Acute Care Surg. 72(1):216-21, 2012
                                    6. Santos-Franco JA et al: Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options. Neurosurg Rev. 31(2):131-40; discussion 140, 2008
                                    7. Chen CJ et al: Multisection CT angiography compared with catheter angiography in diagnosing vertebral artery dissection. AJNR Am J Neuroradiol. 25(5):769-74, 2004
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Synonyms

                                              • Traumatic dissection and pseudoaneurysm
                                            • Definitions

                                              • Dissection: Intramural hematoma extends along vessel wall
                                              • Intimal extension
                                                • Intimal flap
                                                • True and false lumen
                                              • Arterial transection
                                                • Extension through adventitia
                                              • Dissecting aneurysm: Aneurysmal dilation of vessel due to dissection, contained only by adventitia
                                                • Hematoma between media/adventitia common
                                              • Pseudoaneurysm: Lumen contained only by thrombus outside vessel wall

                                            IMAGING

                                            • General Features

                                              • CT Findings

                                                • MR Findings

                                                  • Angiographic Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Kansagra AP et al: Current trends in endovascular management of traumatic cerebrovascular injury. J Neurointerv Surg. 6(1):47-50, 2014
                                                                      2. Prasad V et al: Pipeline endovascular reconstruction of traumatic dissecting aneurysms of the intracranial internal carotid artery. J Neurointerv Surg. 6(10):e48, 2014
                                                                      3. Ro A et al: Pathomorphological differentiation between traumatic rupture and nontraumatic arterial dissection of the intracranial vertebral artery. Leg Med (Tokyo). 16(3):121-7, 2014
                                                                      4. Rahme RJ et al: Spontaneous cervical and cerebral arterial dissections: diagnosis and management. Neuroimaging Clin N Am. 23(4):661-71, 2013
                                                                      5. Cohen JE et al: Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections. J Trauma Acute Care Surg. 72(1):216-21, 2012
                                                                      6. Santos-Franco JA et al: Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options. Neurosurg Rev. 31(2):131-40; discussion 140, 2008
                                                                      7. Chen CJ et al: Multisection CT angiography compared with catheter angiography in diagnosing vertebral artery dissection. AJNR Am J Neuroradiol. 25(5):769-74, 2004