• M Bertram, P Ringleb, J Fiebach, E Orberk, T Brandt, and W Hacke.
• Neuroradiologische Klinik, Ruprecht-Karls-Universität Heidelberg. markus_bertram@ukl.uni-heidelberg.de
• Dtsch. Med. Wochenschr. 1999 Mar 12;124(10):273-8.

Background And ObjectiveDissection of extracranial arteries that supply the brain is a common cause of ischemic stroke in youngish persons. Yet this disease, with its warning and early symptoms, is inadequately known among the population as well as doctors. This study was undertaken to demonstrate the incidence, severity and sequelae of this condition, important in both routine general and hospital practice, with particular emphasis on early signs and diagnosis.Patients And MethodsThe data from 33 patients (20 men, 13 women, average age 42 [21-72] years) who during one year had been treated in the authors' hospital for carotid (n = 23) or vertebral (n = 10) artery dissection were analysed.ResultsThe admission diagnosis of dissection, based on the history and ultrasound findings was in almost all cases confirmed by magnetic resonance imaging (wall haematoma), magnetic resonance angiograhy, computed tomography-angiography or conventional angiography. Typical warning and early symptoms such as whiplash sensation unilateral pain in the throat, neck and head or Horner's syndrome were elicited in nearly 50% of patients, while known causes such as trauma or connective tissue disease were confirmed in only 27%. Neurological deficits of ischemic infarction, some of them severe, persisted in two-thirds of patients, brain death occurred in one.ConclusionsDissection of carotid or vertebral arteries is a statistically and medically relevant cause of stroke in youngish persons that can be diagnosed by attention to typical warning and early symptoms and the performance of noninvasive tests. The often life-threatening sequelae of possible cerebral ischemia can be diagnosed and even averted by early recognition of the cause.

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