PDF herunterladen
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2015; 34(04): 331-334
DOI: 10.1055/s-0035-1564582
Case Report | Relato de Caso
Thieme Publicações Ltda Rio de Janeiro, Brazil.

Traumatic Cervical Artery Dissection and Ischemic Stroke: Anticoagulation or Antiplatelet Therapy? The Controversies Remain

Dissecção traumática da artéria cervical e AVC isquêmico: anticoagulação ou terapia antiplaquetária? A polêmica continua
Leonardo Christiaan Welling
1   Neurosurgeon; Professor at Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
,
Camila Mariana Fukuda
2   Medical School Students at Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
,
Edek Francisco de Mattos da Luz
2   Medical School Students at Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
,
Mariana Schumacher Welling
2   Medical School Students at Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil
,
Eberval Gadelha Figueiredo
3   Neurosurgeon; Professor at Universidade de São Paulo, São Paulo, SP, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

10. November 2013

07. August 2015

Publikationsdatum:
13. Oktober 2015 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Arterial dissection of the wall of the carotid artery is a recognized and significant cause of stroke. We described a 22-year-old man presented to the emergency department after a motorcycle accident. He had a right acetabular fracture and had not complained of other symptoms. A few minutes after being admitted, the patient developed left side hemiparesis. Emergency brain magnetic resonance imaging (MRI) revealed an acute ischemia in the left basal ganglia. Conventional angiography confirmed almost complete occlusion of carotid artery lumen. We treated the patient with antiplatelet therapy and he is currently followed at the outpatient clinic with good recovery of motor symptoms. Early identification and management of cervical artery dissection is important, as it is one of the major causes of ischemic stroke in young adults. Despite previous published articles, the best treatment of carotid artery dissection, especially after trauma, remains controversial.

Resumo

Dissecação da parede da artéria carótida interna é uma causa reconhecida de acidente vascular cerebral. Descrevemos um jovem de 22 anos admitido na emergência após acidente motociclístico. Inicialmente foi diagnosticado somente fratura acetabular, sem nenhuma outra queixa pelo paciente. Poucos minutos após admissão, o paciente evoluiu com hemiparesia esquerda. Encaminhado a ressonância magnética do encéfalo em caráter de urgência, identificou-se isquemia aguda nos gânglios da base à esquerda. Angiografia convencional demonstrou oclusão quase completa da artéria carótida interna. O caso foi tratado com terapia antiagregante plaquetária e atualmente o paciente está em acompanhamento ambulatorial com boa recuperação dos sintomas motores. Como uma das maiores causas de acidente vascular cerebral isquêmico em jovens, a identificação precoce e manejo da dissecação cervical é importante. A depeito dos trabalhos previamente publicados, o melhor tratamento para a dissecação carótidea, especialmente após trauma, permanece controversa.

Keywords

ischemia - carotid artery - dissection

Palavras-chave

isquemia - carótida interna - dissecação
 

  • References

  • 1 Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke 2005; 36 (7) 1575-1580
    CrossrefPubMedGoogle Scholar
  • 2 Redekop GJ. Extracranial carotid and vertebral artery dissection: a review. Can J Neurol Sci 2008; 35 (2) 146-152
    CrossrefPubMedGoogle Scholar
  • 3 Dziewas R, Konrad C, Dräger B , et al. Cervical artery dissection—clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003; 250 (10) 1179-1184
    CrossrefPubMedGoogle Scholar
  • 4 Lee VH, Brown Jr RD, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006; 67 (10) 1809-1812
    CrossrefPubMedGoogle Scholar
  • 5 Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res 2009; 123 (6) 810-821
    CrossrefPubMedGoogle Scholar
  • 6 Arauz A, Hoyos L, Espinoza C, Cantú C, Barinagarrementeria F, Román G. Dissection of cervical arteries: Long-term follow-up study of 130 consecutive cases. Cerebrovasc Dis 2006; 22 (2–3) 150-154
    CrossrefPubMedGoogle Scholar
  • 7 Beletsky V, Nadareishvili Z, Lynch J, Shuaib A, Woolfenden A, Norris JW ; Canadian Stroke Consortium. Cervical arterial dissection: time for a therapeutic trial?. Stroke 2003; 34 (12) 2856-2860
    CrossrefPubMedGoogle Scholar
  • 8 Lyrer P, Engelter S. Antithrombotic drugs for carotid artery dissection. Cochrane Database Syst Rev 2003; (3) CD000255
    PubMedGoogle Scholar
  • 9 Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J ; CADISS trial investigators. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol 2015; 14 (4) 361-367
    CrossrefPubMedGoogle Scholar
  • 10 Georgiadis D, Arnold M, von Buedingen HC , et al. Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients. Neurology 2009; 72 (21) 1810-1815
    CrossrefPubMedGoogle Scholar
  • 11 Schneidereit NP, Simons R, Nicolaou S , et al. Utility of screening for blunt vascular neck injuries with computed tomographic angiography. J Trauma 2006; 60: 209-215 , discussion 215–216
    CrossrefPubMedGoogle Scholar