Document Detail

Treatment issues in spontaneous cervicocephalic artery dissections.
MedLine Citation:
PMID:  21557808     Owner:  NLM     Status:  In-Data-Review    
The management of cervicocephalic arterial dissections raises many unsolved issues such as: how to best acutely treat patients who present with ischemic stroke or occasionally with sub-arachnoid hemorrhage? How to best prevent ischemic stroke in patients who present with purely local signs such as headache, painful Horner Syndrome or neck pain? How long and how should patients be treated after cervicocephalic arterial dissections? Can patients resume their sports activities and when? The consensus is that, given the well-established initial thromboembolic risk, an urgent antithrombotic treatment is required in patients with a recent nonhemorrhagic cervicocephalic arterial dissection, but the type of antithrombotic treatment - anticoagulants or aspirin - as well as the indication for a local arterial treatment such as angioplasty/stenting remain debated. Evidence from a randomized clinical trial would be welcome but such a trial raises major issues of methodology, feasibility and funding. Meanwhile, cervicocephalic arterial dissection remains a situation when a bedside clinician should use, on a case-by-case basis, best clinical judgment and adopt a stepped care approach in the minority of patients who deteriorate despite initial treatment.
Marcel Arnold; Urs Fischer; Marie-Germaine Bousser
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of stroke : official journal of the International Stroke Society     Volume:  6     ISSN:  1747-4949     ISO Abbreviation:  Int J Stroke     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101274068     Medline TA:  Int J Stroke     Country:  England    
Other Details:
Languages:  eng     Pagination:  213-8     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.
Department of Neurology, University Hospital Berne, Inselspital, Berne, Switzerland Assistance Publique Hôpitaux de Paris, Department of Neurology, University Hospital, Lariboisière, Paris, France.
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