Ch83 Cerebral arterial dissections

Question 1

What is a dissection?

Answer 1

Haemorrhage between the intima and tunica media of an artery.

Question 2

What types of aneurysms occur with dissections?

Answer 2

Pseudoaneurysms (don’t have all 3 wal layers)

Question 3

What condition is associated with arterial dissections?

Answer 3

Fibromuscular dysplasia found in 15%

Other connective tissue disorders e.g. Marfan’s / Ehler’s danlos etc.

Question 4

What is the most common site of a dissection?

Answer 4

Vertebral artery L>R

Question 5

What are the DSA findings with a dissection?

Answer 5

Luminal stenosis
Intimal flap
String and peal sign = fusiform dilation with proximal / distal narrowing. Note - string of bead is indicative of fibromuscular dysplasia
Double lumen sign

Question 6

What is associated with carotid dissection?

Answer 6

Neck pain and Horner’s syndrome. Note there is no anhidrosis as the sympathetics on the ECA are spared. Listen for a carotid bruit.

Question 7

Where are vertebral dissections most likely to occur?

Answer 7

Over bony prominances e.g. C1/2 and C6

Question 8

What is the treatment of dissection?

Answer 8

Anticoagulation / antiplatelets if no bleed
Endovascular stenting
Surgery = clipping or hunterian ligation