Article

Sonographic Features of Craniocervical Artery Dissection

Acta Clinica Croatica; Vol.41 No.4 12/2002; 41(4).
Source: OAI

ABSTRACT Craniocervical artery dissection (CCAD) is primarily diagnosed by angiography, brain magnetic resonance (MR) or MR angiography. Color Doppler flow imaging (CDFI) has been underrated due to the localization of dissection, which appears to be most commonly localized intracranially. Nevertheless, dissection may manifest in various ways, enabling CDFI to present a broad spectrum of findings. The aim of this study was to analyze ultrasonographic findings in patients with clinical or ultrasonographic presentation of CCAD. Forty-three patients who presented with CCAD over a two-year period were retrospectively analyzed. Twenty-three of these patients showed clinical manifestations of CCAD, whereas in 19 patients ultrasound revealed double lumen or bifurcation stenosis with double lumen. Carotid and vertebral CDFI was performed on an Acuson 128 XP device. Color and power Doppler scans and hemodynamic spectra were analyzed. Data are presented descriptively. Data on 43 patients (28 male and 15 female, mean age 59±11 years) were analyzed. There were 49 ultrasonographically detected dissected vessels (37 carotid, 10 vertebral and 2 subclavian arteries). A string sign was found in 5 patients (5 internal carotid arteries (ICA)), string and pearl sign in 2 patients (1 ICA and 1 vertebral artery (VA)), subintimal flow in one patient (1 ICA), double lumen in 12 patients (3 common carotid arteries (CCA), 7 ICA, 3 VA and 2 subclavian arteries); one patient presented as VA dissection and subarachnoid hemorrhage (SAH; ICA dissection on ultrasonography); carotid stenosis with double lumen under the plaque base was found in 17 patients (2 ACC, 13 bifurcation stenoses, and 2 ICA stenoses with dissection under the plaque base); hemodynamic spectra suggesting distal occlusion were detected in 8 patients (3 ICA, 6 VA); and multiple vessel involvement was present in 7 (16%) patients. Ultrasound can show a broad spectrum of findings in CCAD including direct evidence for intimal flap and detectable subintimal flow as well as signs of hemodynamically significant flow obstruction.

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Available from: Arijana Lovrenčić-Huzjan, Aug 18, 2015
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    • "Intracranial dissections in the vertebrobasilar territory have a higher risk of rupture, leading to a subarachnoidal hemorrhage (SAH). Dissections may appear as different findings in the color-coded Doppler mode [26] [27] [28] [29] [30]. When extending from the aortic arch, double lumens can be seen. "
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    ABSTRACT: Vertigo is a common symptom, and may represent a serious neurological disorder. If it develops suddenly, it may be a symptom of an acute stroke. Neurosonology can be used in cerebrovascular disorders in order to asses the vessel patency, or to present different craniocervical artery diseases. Atherosclerotic changes may be seen, as well as inflammatory diseases, dissections, vasculopathies or vascular malformations. By means of a transcranial Doppler the intracranial hemodynamics can be assessed. A development of collateral pathways in extra- or intracranial occlusive diseases can be presumed, cerebral vasomotor reactivity can be tested, and, with the application of new softwares, microembolic signals can be detected. Neurosonology can be used in a variety of neurological disorders presenting with vertigo.
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    • "Intracranial dissections in the vertebrobasilar territory have a higher risk of rupture, leading to a subarachnoidal hemorrhage (SAH). Dissections may appear as different findings in the color-coded Doppler mode [26] [27] [28] [29] [30]. When extending from the aortic arch, double lumens can be seen. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Vertigo is a common symptom, and may represent a serious neurological disorder. If it develops suddenly, it may be a symptom of an acute stroke. Neurosonology can be used in cerebrovascular disorders in order to asses the vessel patency, or to present different craniocervical artery diseases. Atherosclerotic changes may be seen, as well as inflammatory diseases, dissections, vasculopathies or vascular malformations. By means of a transcranial Doppler the intracranial hemodynamics can be assessed. A development of collateral pathways in extra-or intracranial occlusive diseases can be presumed, cerebral vasomotor reactivity can be tested, and, with the application of new softwares, microembolic signals can be detected. Neurosonology can be used in a variety of neurological disorders presenting with vertigo.
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    ABSTRACT: Craniocervical arterial dissection is an under-recognized and uncommon cause of stroke. We describe a 66-year-old hypertensive female patient who developed internal carotid artery dissection at an atypical location, with consequential ischemic stroke. Double lumen was visible by color doppler flow imaging, and high-intensity transient signals were detected. Transcranial doppler ultrasonography was used to monitor cessation of ipsilateral distal microembolization associated with clinical improvement on anticoagulant therapy. In embolic stroke due to embolization from a dissected internal carotid artery, neurosonologic investigations enabled noninvasive visualization and monitoring of the time course of vessel dissection and secondary embolism.
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