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Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?

Debette, Stéphaniea,b,c,d

doi: 10.1097/WCO.0000000000000056

Purpose of review Cervical artery dissection (CeAD) is a major cause of ischemic stroke in young and middle-aged adults, although relatively uncommon in the community. Recent large collaborative projects have provided new insights into mechanisms and risk factors of CeAD.

Recent findings Pathologic changes observed at the media–adventitia border in temporal arteries of CeAD patients suggest a predisposing arterial wall weakness. In large multicenter series of CeAD patients, compared to age-matched healthy controls and patients with an ischemic stroke of another cause, hypertension and migraine, especially without aura, were confirmed as risk factors for CeAD, in addition to cervical trauma and recent infection. Hypercholesterolemia and being overweight were shown to be inversely associated with CeAD. Differences in risk factor profile and structural features between carotid and vertebral dissection suggest that their pathophysiology may partly differ. An association of CeAD with fibromuscular dysplasia and reversible cerebral vasoconstriction syndrome was described. Genetic risk factors of CeAD are still poorly understood.

Summary Large cohorts of CeAD patients have refined our understanding of the pathophysiology and risk factors of CeAD, but the molecular mechanisms are still poorly understood. Ongoing high-throughput genetic projects will hopefully provide novel insight into the biological substrate of CeAD.

aDepartment of Neurology, Lariboisière Hospital

bInserm Unit U740

cParis 7 University, DHU Neurovasc Sorbonne Paris-Cité, Paris, France

dDepartment of Neurology, Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts, USA

Correspondence to Stéphanie Debette, MD, PhD, Service de Neurologie, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France. Tel: +33 01 49 95 25 97; fax: +33 01 49 95 25 96

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