Cervical Artery Dissection

What is cervical artery dissection?

Cervical artery dissection happens when there’s a tear in one or more layers of blood vessel tissue. Cervical artery dissection is a common cause of stroke in young and middle-aged adults.

Your cervical arteries are a group of large blood vessels in your neck. They include the carotid arteries (which supply the front part of your brain) and vertebral arteries (which supply the back of your brain and your spine).

How can a cervical artery dissection affect my health?

With a carotid artery dissection, the inner lining of the blood vessel tears. At the site of the tear, blood can clot. If the blood clot breaks loose, it can travel to your brain, block off blood vessels and limit blood flow, resulting in an ischemic stroke.

What causes cervical artery dissection?

Injury to your head or neck (from a car accident or similar trauma) is the most common cause of dissection. Non-traumatic dissections can occur due to straining or heavy lifting in some people.

Connective tissue disorders

Examples of genetic conditions that affect connective tissue throughout your body include:

• Ehlers-Danlos syndrome.
• Fibromuscular dysplasia.
• Marfan syndrome.
• Osteogenesis imperfecta.

Neck trauma

Neck sprain and injuries can occur due to:

• History of neck injuries, like whiplash from a motor vehicle accident.
• Extreme head positions for long periods (for example, painting a ceiling).
• Rapid movements of the head (for example being on a rollercoaster, chiropractic neck manipulation).
• Weightlifting and carrying heavy objects.

Recent illnesses

Illnesses that cause straining can lead to cervical artery dissection. These include:

• Gastrointestinal upset that causes frequent vomiting.
• Upper respiratory infection with persistent coughing.

Other risk factors

Additional conditions that put you at risk include:

• Atherosclerosis.
• High blood pressure.
• Smoking.

What are cervical artery dissection symptoms?

Many people start noticing symptoms up to a month before receiving a cervical artery dissection diagnosis. There are three main types, including:

• Severe and sudden head pain (particularly behind one eye) or neck pain.
• Stroke-like symptoms.

Head or neck pain

You may experience head or neck pain not related to an existing health issue. Discomfort typically:

• Comes on suddenly.
• Doesn't go away.
• Is on one side of your head (especially behind one eye) or neck.
• Resembles a cluster, migraine or thunderclap headache.

Horner’s syndrome

This condition affects the involuntary function of your eyes and face. Symptoms include drooping eyelids, a smaller pupil in one eye and a lack of sweating. Horner's syndrome typically impacts only one side of your head.

Stroke-like symptoms

These cervical artery dissection symptoms occur when part of your brain isn’t getting enough blood. They include:

• Ataxia.
• Balance problems.
• Blurred vision.
• Dizziness.
• Double vision (diplopia).
• Limb weakness.
• Speech difficulty (dysarthria or aphasia).
• Vertigo.

Who should be evaluated for cervical artery dissection?

Cervical artery dissection can be challenging to detect, but certain symptoms should raise a healthcare provider’s suspicion. You should inform your healthcare provider if you develop any of the symptoms mentioned above.

How is cervical artery dissection diagnosed?

Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are good methods for detecting a dissection. These techniques take specific pictures of your blood vessels.

How is cervical artery dissection treated?

Dissections often heal on their own. Medical therapies can lower your risk of blood clots that can lead to stroke.

You may need:

• Antiplatelet therapy, which includes drugs such as aspirin and clopidogrel that prevent blood cells from clumping together.
• Anticoagulant medications (blood thinners), such as heparin infusion or warfarin tablets.

What if standard therapies are not successful?

Occasionally, procedures like stenting are necessary. Stenting uses a mesh device to reinforce and expand blood vessel walls.

How can I prevent a cervical artery dissection?

If you have an underlying condition that increases your dissection risk, it’s important to receive ongoing monitoring from a vascular specialist.

All people at risk for cervical artery dissection should optimize their health by:

• Avoiding prolonged extreme neck positions (like painting a ceiling).
• Avoiding rapid head and neck movements (like going on rollercoasters and chiropractic neck manipulation).
• Avoiding heavy lifting (requiring straining to lift).
• Eating a heart-healthy diet.
• Exercise regularly. (Talk to your healthcare provider about a personalized plan.)
• Managing blood pressure, which may include taking ACE inhibitors.
• Quitting smoking.

What is the prognosis for people with cervical artery dissection?

Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months.

What’s it like living with a cervical artery dissection?

You’ll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. You may also need to continue antiplatelet medications or anticoagulant therapy during this time.