Cervical artery dissection (CAD) - carotid and vertebral artery dissection
Overview
Cervical artery dissection is an important and often underdiagnosed cause of ischaemic stroke, particularly in younger patients. It is characterised by an intramural haematoma of the arterial wall (from vasa vasorum haemorrhage or an intimal tear) producing luminal narrowing, thrombus formation and distal embolism.
Large haematomas or pseudo‑aneurysms can cause local compressive symptoms. CAD accounts for roughly 10-15% of ischaemic strokes in people under 45. Carotid dissections are more common than vertebral dissections.
Pathophysiology An intramural haematoma or intimal flap leads to:
- Luminal stenosis or occlusion and endothelial disruption → local thrombus formation and embolic stroke.
- Pseudo‑aneurysm formation or mass effect → local neural or sympathetic compression.
Predisposing factors
- Recent neck trauma or sudden neck movement - ranges from major injury to trivial events (sneezing, coughing, sports, chiropractic manipulation, yoga).
- Underlying arteriopathy: fibromuscular dysplasia, connective tissue disorders (vascular Ehlers-Danlos, Marfan), cystic medial degeneration.
- Recent upper respiratory infection reported in some series.
- Frequently occurs with no clear precipitant.