Cerebral artery dissection secondary to antiphospholipid syndrome: A report of two cases and a literature review

Introduction Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thromboembolic events, including ischemic stroke or complications in pregnancy, and the presence of antiphospholipid antibodies. Cervical artery dissection (CAD) is not an uncommon cause of stroke in young adults. The concomitant presence of APS and CAD is extremely rare. Methods Two cases with APS who developed acute ischemic strokes related to CAD are reported. A comprehensive systematic literature search using the PubMed database was also conducted. Results In Case 1, a 36-year-old woman who had been diagnosed with systemic lupus erythematosus and had been repeatedly positive for lupus anticoagulant tests developed an ischemic stroke caused by a vertebral artery dissection (VAD). After admission, she had a recurrent ischemic stroke, followed by considerable changes in steno-occlusive lesions of the vertebrobasilar artery system. In Case 2, a 36-year-old man developed multiple brain infarcts due to bilateral VAD with aneurysmal formations and associated with pulmonary embolism. The anticardiolipin antibody titer was repeatedly elevated after stroke. The literature review identified 8 patients with CAD associated with APS, involving the internal carotid artery in 6 patients and the middle cerebral artery and vertebral artery in 1 patient each. The patients were predominantly young and female, infrequently had atherosclerotic vascular risk factors, and were positive for various antiphospholipid antibodies. Conclusions The current report described two rare cases of ischemic stroke caused by CAD secondary to APS, along with a review of the literature; the patients displayed characteristic clinical manifestations, implying specific mechanisms for cerebral artery disorders secondary to APS.

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Oral Anticoagulant and Antiplatelet Therapy for Cervical Artery Dissection: A Meta-Analysis of Clinical Trials

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211051708 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110517

Author(s):

Sheng-Lin Ye ◽

Chuang Wang ◽

Lu-Lu Wang ◽

Tian-Ze Xu ◽

Xiao-Qiang Li ◽

...

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Vertebral Artery ◽

Antiplatelet Therapy ◽

Meta Analysis ◽

Antiplatelet Agents ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Curative Effect ◽

Ischemic Attack

Carotid and vertebral artery dissections are estimated to account for ∼20% of strokes in patients under 45-years-old. This meta-analysis compared the efficacy and safety of treatment with anticoagulants versus antiplatelet agents to determine the optimal therapy. We searched 4 electronic databases for clinical trials published from January 1, 1980 to August 25, 2021 that included patients who received anticoagulant or antiplatelet therapy for carotid and/or vertebral artery dissections. The curative effect was judged by recanalization evaluated by imaging. The primary outcomes were all cause death and ischemic stroke; secondary outcomes included hemorrhage and transient ischemic attack (TIA). Patients who received only a single drug treatment were divided into antiplatelet or anticoagulant groups; all received conservative treatment without surgical intervention. For this investigation, we pooled the available studies to conduct a meta-analysis, which included 7 articles with 1126 patients. The curative effect of vascular recanalization was not significantly different between the 2 treatment groups (odds ratio [OR] = 0.913, 95% confidence interval [CI]: 0.611-1.365, P = .657); similarly, no significant differences were found regarding the primary outcomes all cause death (OR = 1.747, 95%CI: 0.202-15.079, P = .612) and ischemic stroke (OR = 2.289, 95%CI: 0.997-5.254, P = .051). Patients treated with anticoagulants were more likely to experience TIA (OR = 0.517, 95%CI: 0.252-1.060, P = .072) and hemorrhage (OR = 0.468, 95%CI: 0.210-1.042, P = .063), but the differences were not statistically significant. Overall, there were no statistically significant differences between anticoagulant therapy and antiplatelet therapy for the treatment of carotid and vertebral artery dissections.

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Ischemic stroke with vertebrobasilar artery dissection extended to posterior cerebral artery

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-001047 ◽

2017 ◽

Vol 57 (8) ◽

pp. 446-450

Author(s):

Shinji Ashida ◽

Yoshinari Nagakane ◽

Masahiro Makino ◽

Kei Tomonaga ◽

Naoki Makita ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Artery Dissection ◽

Vertebrobasilar Artery

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Intracranial Cerebral Artery Dissection of Anterior Circulation as a Cause of Convexity Subarachnoid Hemorrhage

Cerebrovascular Diseases ◽

10.1159/000430945 ◽

2015 ◽

Vol 40 (1-2) ◽

pp. 45-51 ◽

Cited By ~ 16

Author(s):

Kazuki Fukuma ◽

Masafumi Ihara ◽

Tomotaka Tanaka ◽

Yoshiaki Morita ◽

Kazunori Toyoda ◽

...

Keyword(s):

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Internal Carotid ◽

Border Zone ◽

Artery Dissection ◽

Early Reperfusion ◽

Cerebral Magnetic Resonance Imaging ◽

Vertebrobasilar Artery ◽

Cerebral Artery Dissection

Background: Convexity subarachnoid hemorrhage (cSAH), defined as intrasulcal bleeding restricted to hemispheric convexities, has several etiologies: reversible cerebral vasoconstriction syndrome, cerebral amyloid angiopathy, and internal carotid artery (ICA) stenosis or occlusion. However, it remains unknown whether cerebral artery dissection causes cSAH. Methods: We retrospectively investigated patients admitted to our hospital between 2005 and 2013 with ischemic stroke or transient ischemic attack caused by cerebral artery dissection. Cerebral artery dissection was diagnosed by cervical or cerebral magnetic resonance imaging (MRI) or computed tomography (CT) showing a wall hematoma. CT angiography, ultrasonography, or intra-arterial digital-subtraction angiography detected cerebral artery dissection if a double lumen, string sign, intimal flap, or dissecting aneurysm was observed at a nonbifurcation site. We used CT or MRI to detect cSAH, which was defined as blood collection restricted to one or few cerebral sulci without extending to the basal cisterns, ventricles, or Sylvian and interhemispheric fissures. Demographic, neuroimaging, treatment, and prognostic data were collected. Results: In total, 82 patients were diagnosed with ischemic stroke caused by cerebral artery dissection. The following arteries were affected: the ICA (9 patients), anterior cerebral artery (ACA; 12 patients), middle cerebral artery (MCA; 12 patients), vertebral artery (37 patients), basilar artery (5 patients), posterior cerebral artery (2 patients), and posterior inferior cerebellar artery (4 patients). In addition, 1 patient presented with simultaneous dissection in both the vertebral and internal carotid arteries, and 6 patients (7%) presented with cSAH (3 men and 3 women, age 39-67 years). The MCA was dissected in four cases and the ACA in two cases, with cSAH frequencies of 33 (4 of 12) and 17% (2 of 12), respectively, in those vessels. Artery dissection in the vertebrobasilar artery system was not responsible for cSAH (0 of 48). In all the MCA dissection cases, cSAH occurred in the arterial border zone between the ACA and MCA territories. Although 2 patients showed early reperfusion with temporary cSAH enlargement, cSAH was self-limiting. Antithrombotic treatment did not complicate the clinical course when used in 4 patients during acute or subacute phases. All patients achieved a 3-month poststroke modified Rankin Scale of 0-2. Conclusion: Our data suggest that cSAH caused by intracranial cerebral artery dissection is not rare. Further investigations are needed to elucidate the precise mechanism underlying cSAH in cerebral artery dissection.

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Clinical-therapeutic and recuperators complex aspects in a chronic ethanol-consuming patient with incomplete AIS/Frankel D tetraplegia after cervical SCI on the background of ankylosing spondylitis, with C6 transosus fracture operated (by mixed osteosynthesis) and immobilized in the halo-vest by falling from its own level and the posterior cerebral artery ischemic stroke (possibly by vertebral artery dissection

Balneo Research Journal ◽

10.12680/balneo.2018.206 ◽

2018 ◽

Vol 9 (3) ◽

pp. 228-331 ◽

Cited By ~ 1

Author(s):

Simona-Isabelle Stoica ◽

◽

Carmen Chipăruș ◽

Magdalena Lapadat ◽

Andreea Dumitrascu ◽

...

Keyword(s):

Ischemic Stroke ◽

Ankylosing Spondylitis ◽

Vertebral Artery ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Vertebral Artery Dissection ◽

Chronic Ethanol ◽

Artery Dissection ◽

Halo Vest

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Traumatic Dissection of Arterial Cervical Vessels: Report of Two Cases and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1718422 ◽

2020 ◽

Author(s):

Guilherme Finger ◽

Tobias Ludwig do Nascimento ◽

Julia Carolina Lusa Tessaro ◽

Eduarda Tanus Stefani ◽

Maria Eduarda Conte Gripa ◽

...

Keyword(s):

Literature Review ◽

Acute Phase ◽

Clinical Signs ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Cervical Artery

AbstractEven though traumatic dissection of cervical arterial vessels is the major cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject.

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Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection

Stroke ◽

10.1161/strokeaha.118.021868 ◽

2018 ◽

Vol 49 (10) ◽

pp. 2337-2344 ◽

Cited By ~ 5

Author(s):

J. Scott McNally ◽

Peter J. Hinckley ◽

Akihiko Sakata ◽

Laura B. Eisenmenger ◽

Seong-Eun Kim ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Resonance Imaging ◽

Clinical Factors ◽

Factors Associated ◽

Cervical Artery

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The migraine–stroke connection: A genetic perspective

Cephalalgia ◽

10.1177/0333102415621055 ◽

2015 ◽

Vol 36 (7) ◽

pp. 658-668 ◽

Cited By ~ 12

Author(s):

Rainer Malik ◽

Bendik Winsvold ◽

Eva Auffenberg ◽

Martin Dichgans ◽

Tobias Freilinger

Keyword(s):

Ischemic Stroke ◽

Vascular Disease ◽

Molecular Mechanisms ◽

Association Studies ◽

Familial Hemiplegic Migraine ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Data Sets ◽

Genome Wide Association Studies ◽

Disease Manifestation

Background A complex relationship between migraine and vascular disease has long been recognized. The pathophysiological basis underlying this correlation is incompletely understood. Aim The aim of this review is to focus on the migraine–vascular disorders connection from a genetic perspective, illustrating potentially shared (molecular) mechanisms. Results We first summarize the clinical presentation and genetic basis of CADASIL and other monogenic vascular syndromes with migraine as a prominent disease manifestation. Based on data from transgenic mouse models for familial hemiplegic migraine, we then discuss cortical spreading depression as a potential mechanistic link between migraine and ischemic stroke. Finally, we review data from genome-wide association studies, with a focus on overlapping findings with cervical artery dissection, ischemic stroke in general and cardiovascular disease. Conclusion A wealth of data supports a genetic link between migraine and vascular disease. Based on growing high-throughput data-sets, new genotyping techniques and in-depth phenotyping, further insights are expected for the future.

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