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Cervical artery dissection

Published by Bupa's health information team, March 2009.

This factsheet is for people who have had a cervical artery dissection, or who would like more information about it.

Cervical artery dissection is one of the most common causes of stroke in people under the age of 50. A cervical artery dissection happens when the lining in one of the arteries in your neck is torn, restricting the blood supply to your brain and causing brain cells to die (a stroke).

About cervical artery dissection
Symptoms of cervical artery dissection
Causes of cervical artery dissection
Diagnosis of cervical artery dissection
Treatment of cervical artery dissection
After your treatment
Further information
Questions and answers
Related topics
Sources

About cervical artery dissection

Blood vessels called arteries carry blood to various parts of your body. Two major arteries in your neck, called the carotid artery and the vertebral artery, carry blood to your brain. Together these are called the cervical arteries.

In cervical artery dissection, the lining of one of the cervical arteries becomes torn. Tears happen more often in the carotid artery (carotid artery dissection) than the vertebral artery (vertebral artery dissection). The tear in the artery wall causes the blood around the tear to clot, blocking off the artery or weakening the artery wall.

A disruption of the blood flow can starve parts of the brain of oxygen and nutrients. This damages brain cells and they begin to die. Your brain controls everything your body does, including your movement, speech, vision and emotions. So a stroke can affect any of these functions.

Symptoms of cervical artery dissection

Symptoms of carotid artery dissection can be slightly different to those of vertebral artery dissection, although both can cause an ischaemic stroke, sometimes without any other symptoms beforehand (see Related topics for more information on ischaemic stroke).

Carotid artery dissection can cause:

severe headache
pain in your neck or face
problems with your vision and/or drooping of your eyelid
reduced taste sensation
tinnitus (ringing in your ears)

Vertebral artery dissection can cause:

pain and numbness in your face
problems with speech and/or swallowing
reduced pain and temperature sensation on one side of your body
reduced taste sensation
loss of hearing
hiccups
vertigo - this is the sensation that you, or things around you are moving, even when you're standing still
problems with balance
feeling sick and vomiting
double vision

If you have any of these symptoms you should see your GP.

Causes of cervical artery dissection

Cervical artery dissection can be caused by any kind of injury to your neck, including from:

high-impact injury, eg from a car crash
sports, including yoga and gymnastics
straining your neck, eg from coughing or sneezing
stretching your neck too far, eg by painting the ceiling

You will usually get symptoms within hours of an injury happening, but they can follow weeks or even months later.

Some people get a cervical artery dissection without any apparent neck injury. However, these people sometimes have an underlying condition affecting the blood vessels that can increase their risk of cervical artery dissection. These include Ehlers-Danlos syndrome, fibromuscular dysplasia and Marfan syndrome.

Diagnosis of cervical artery dissection

Your GP or doctor at the hospital will ask about your symptoms and examine you. He or she may also ask you about your medical history.

You may be asked to have a number of different tests in hospital to confirm whether you have a cervical artery dissection. This will usually include a magnetic resonance (MR) angiogram, which uses magnets and radiowaves to produce images of the blood vessels in your neck.

Other imaging tests you may have include:

a standard angiogram - this uses an injection of a special dye (contrast medium) into the blood vessels, which makes them clearly visible on X-ray
CT scan - this uses X-rays to make a three-dimensional image of your blood vessels
ultrasound - this uses sound waves to produce an image of the inside of the body or part of the body

Treatment of cervical artery dissection

Cervical artery dissections usually go away on their own as the artery heals. Treatment is aimed at preventing further symptoms and stroke while the affected artery heals. You will usually need to stay in hospital until your risk of stroke has decreased and your condition is stable. You will be closely monitored while in hospital.

Medicines

You will usually just need treatment with medicine while you recover from cervical artery dissection. You may be prescribed one of the following:

anticoagulant medicine - this is usually heparin, which is given through a drip in a vein in your arm, followed by warfarin tablets
antiplatelet medicine - this includes aspirin and clopidogrel

These medicines help to prevent your blood from clotting, thus reducing your chance of getting a stroke.

Surgery

If the damage to your artery is getting worse or is not responding to treatment with medicines, you doctor may advise you to have a procedure called angioplasty and stenting. In this procedure, small tubes called stents are inserted into your artery to keep the blood vessel open and restore the blood flow to your brain.

After your treatment

You have a good chance of a full recovery if your cervical artery dissection is diagnosed and treated early. However, you will need to have regular follow-up studies, including more imaging tests, until you have recovered. It usually takes about three to six months for your artery to heal completely.

Further information

The Stroke Association
0845 3033100
www.stroke.org.uk