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Vertebral Dissection
C. Douglas Phillips, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        TERMINOLOGY

        • Abbreviations

          • Vertebral artery dissection (VAD); spontaneous vertebral artery dissection (SVAD)
        • Definitions

          • Hemorrhage into damaged vessel wall with subsequent stenosis, pseudoaneurysm, rupture, or distal embolization

        IMAGING

        • General Features

          • CT Findings

            • MR Findings

              • Angiographic Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Shea K et al: Carotid and vertebral arterial dissections in the emergency department. Emerg Med Pract. 14(4):1-23; quiz 23-4, 2012
                                    2. Arnold M et al: Treatment issues in spontaneous cervicocephalic artery dissections. Int J Stroke. 6(3):213-8, 2011
                                    3. Fusco MR et al: Cerebrovascular dissections--a review part I: spontaneous dissections. Neurosurgery. 68(1):242-57; discussion 257, 2011
                                    4. Pham MH et al: Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery. 68(4):856-66; discussion 866, 2011
                                    5. Provenzale JM et al: Causes of misinterpretation of cross-sectional imaging studies for dissection of the craniocervical arteries. AJR Am J Roentgenol. 196(1):45-52, 2011
                                    6. Ringer AJ et al: Screening for blunt cerebrovascular injury: selection criteria for use of angiography. J Neurosurg. 112(5):1146-9, 2010
                                    7. Debette S et al: Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 8(7):668-78, 2009
                                    8. Provenzale JM et al: Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 193(4):1167-74, 2009
                                    9. Thorisson HM et al: Endovascular management of extracranial carotid and vertebral disease. Neurosurg Clin N Am. 20(4):487-506, 2009
                                    10. Albuquerque FC et al: Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus. 18(2):E3, 2005
                                    11. Iihara K et al: Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg. 97(2):259-67, 2002
                                    12. Provenzale JM: Dissection of the internal carotid and vertebral arteries: imaging features. AJR Am J Roentgenol. 165(5):1099-104, 1995
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Pathology

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Vertebral artery dissection (VAD); spontaneous vertebral artery dissection (SVAD)
                                          • Definitions

                                            • Hemorrhage into damaged vessel wall with subsequent stenosis, pseudoaneurysm, rupture, or distal embolization

                                          IMAGING

                                          • General Features

                                            • CT Findings

                                              • MR Findings

                                                • Angiographic Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Shea K et al: Carotid and vertebral arterial dissections in the emergency department. Emerg Med Pract. 14(4):1-23; quiz 23-4, 2012
                                                                      2. Arnold M et al: Treatment issues in spontaneous cervicocephalic artery dissections. Int J Stroke. 6(3):213-8, 2011
                                                                      3. Fusco MR et al: Cerebrovascular dissections--a review part I: spontaneous dissections. Neurosurgery. 68(1):242-57; discussion 257, 2011
                                                                      4. Pham MH et al: Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery. 68(4):856-66; discussion 866, 2011
                                                                      5. Provenzale JM et al: Causes of misinterpretation of cross-sectional imaging studies for dissection of the craniocervical arteries. AJR Am J Roentgenol. 196(1):45-52, 2011
                                                                      6. Ringer AJ et al: Screening for blunt cerebrovascular injury: selection criteria for use of angiography. J Neurosurg. 112(5):1146-9, 2010
                                                                      7. Debette S et al: Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 8(7):668-78, 2009
                                                                      8. Provenzale JM et al: Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 193(4):1167-74, 2009
                                                                      9. Thorisson HM et al: Endovascular management of extracranial carotid and vertebral disease. Neurosurg Clin N Am. 20(4):487-506, 2009
                                                                      10. Albuquerque FC et al: Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus. 18(2):E3, 2005
                                                                      11. Iihara K et al: Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg. 97(2):259-67, 2002
                                                                      12. Provenzale JM: Dissection of the internal carotid and vertebral arteries: imaging features. AJR Am J Roentgenol. 165(5):1099-104, 1995