Cervical Artery Dissection and Sports

Cervical artery dissection (CeAD) occurring in the context of sports is a matter of concern for CeAD patients. They seek advice on the role of sports in CeAD and on the safety of resuming sports after CeAD. The scarcity of studies and guidelines addressing these issues poses a challenge. We aimed at summarizing the current knowledge about CeAD and sports in order to provide an informed, comprehensive opinion for counseling CeAD patients. We took into account pathophysiological considerations, observations of cases reports, series, and registries, and conclusions by analogy from aortic dissection or inherited connective tissue syndromes. In summary, practicing active sports as the cause of CeAD seems uncommon. It seems recommendable to refrain from any kind of sports activities for at least 1 month, which can be extended in case of an unfavorable clinical or neurovascular course. We recommend starting with sport activities at low intensity—preferably with types of endurance sports—and to gradually increase the pace in an individually tailored manner, taking into circumstances of the occurrences of the CeAD in the individual patient (particularly in relation to sports), the meaning of sports activities for the individual well-being, the presence or absence of comorbidities and of neurological sequela, neurovascular findings, and whether there are signs of an underlying connective tissue alteration. Major limitations and several forms of bias are acknowledged. Still, in the absence of any better data, the summarized observations and considerations might help clinicians in advising and counseling patients with CeAD in clinical practice.

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Spontaneous cervical artery dissection: a fluoroquinolone induced connective tissue disorder?

Chiropractic & Manual Therapies ◽

10.1186/s12998-018-0193-z ◽

2018 ◽

Vol 26 (1) ◽

Cited By ~ 2

Author(s):

James S. Demetrious

Keyword(s):

Connective Tissue ◽

Connective Tissue Disorder ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Cervical Artery

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Aberrations of dermal connective tissue in patients with cervical artery dissection (sCAD)

Journal of Neurology ◽

10.1007/s00415-008-0585-4 ◽

2008 ◽

Vol 255 (3) ◽

pp. 340-346 ◽

Cited By ~ 13

Author(s):

P. Uhlig ◽

P. Bruckner ◽

R. Dittrich ◽

E. B. Ringelstein ◽

G. Kuhlenbäumer ◽

...

Keyword(s):

Connective Tissue ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Cervical Artery ◽

Dermal Connective Tissue

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Abstract WP187: Diagnostic Significance of Connective Tissue Dysplasia Signs in Patients With Cervical Artery Dissection

Stroke ◽

10.1161/str.49.suppl_1.wp187 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Mariia Gubanova ◽

Ludmila Kalashnikova ◽

Kamila Shamtieva ◽

Larisa Dobrynina

Keyword(s):

Connective Tissue ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Diagnostic Significance ◽

Cervical Artery ◽

Connective Tissue Dysplasia

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Extracellular matrix protein signature of recurrent spontaneous cervical artery dissection

Neurology ◽

10.1212/wnl.0000000000010710 ◽

2020 ◽

Vol 95 (15) ◽

pp. e2047-e2055 ◽

Cited By ~ 1

Author(s):

Lukas Mayer ◽

Raimund Pechlaner ◽

Javier Barallobre-Barreiro ◽

Christian Boehme ◽

Thomas Toell ◽

...

Keyword(s):

Connective Tissue ◽

Quantitative Proteomics ◽

Matrix Protein ◽

Extracellular Matrix Protein ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Proteomics Approach ◽

Cervical Artery ◽

Patients At Risk ◽

Protein Signature

ObjectiveTo assess whether connective tissue disorder is evident in patients with spontaneous cervical artery dissection and therefore identify patients at risk of recurrence using a cutting-edge quantitative proteomics approach.MethodsIn the ReSect study, all patients with spontaneous cervical artery dissection treated at the Innsbruck University Hospital since 1996 were invited to attend a standardized clinical follow-up examination. Protein abundance in skin punch biopsies (n = 50) was evaluated by a cutting-edge quantitative proteomics approach (liquid chromatography–mass spectrometry) that has hitherto not been applied to such patients.ResultsPatients with 1-time single-vessel (n = 19) or multiple-vessel (n = 13) dissections did not differ between each other or compared to healthy controls (n = 12) in protein composition. Patients with recurrent spontaneous cervical artery dissection (n = 6), however, showed significantly different expression of 25 proteins compared to the other groups combined. Literature review and Gene Ontology term annotation check revealed that 13 of the differently expressed proteins play a major role in the structural integrity of connective tissue or are linked to connective tissue disorders. These proteins showed clustering to a collagen/elastin cluster and one consisting of desmosome related proteins.ConclusionThis study unravels an extracellular matrix protein signature of recurrent spontaneous cervical artery dissection. In the long run and after large-scale validation, our findings may well assist in identifying patients at risk of recurrent spontaneous cervical artery dissection and thus guide therapy.

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Recurrence of cervical artery dissection

Neurology ◽

10.1212/wnl.0000000000005324 ◽

2018 ◽

Vol 90 (16) ◽

pp. e1372-e1378 ◽

Cited By ~ 11

Author(s):

Manja Kloss ◽

Caspar Grond-Ginsbach ◽

Peter Ringleb ◽

Ingrid Hausser ◽

Werner Hacke ◽

...

Keyword(s):

Connective Tissue ◽

Recurrent Events ◽

Clinical Symptoms ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Consecutive Series ◽

Initial Event ◽

Cervical Artery ◽

Tissue Abnormalities

ObjectiveTo explore the recurrence of cervical artery dissection (CeAD).MethodsA single-center consecutive series of 282 CeAD patients was prospectively recruited during first admission from 1995 to 2012. Patients with a follow-up of at least 1 year (n = 238) were eligible for the current analysis. All patients with clinical symptoms or signs of recurrent CeAD on ultrasound were examined by MRI. Dermal connective tissue morphology was studied in 108 (45.4%) patients.ResultsMedian follow-up was 52 months (range 12–204 months). In all, 221 (92.8%) patients presented with monophasic CeAD, including 188 (79.0%) patients with a single CeAD event, 11 (4.6%) with simultaneous dissections in multiple cervical arteries, and 22 (9.2%) with subsequent events within a single phase of 4 weeks. Seventeen patients (7.1%) had late (>1 month after the initial event) recurrent CeAD events, including 5 (2.1%) with multiple recurrences. Patients with late recurrences were younger (37.5 ± 6.9 years) than those without (43.8 ± 9.9; p = 0.011). Ischemic stroke occurred in 164 (68.9%) patients at first diagnosis, but only 4 of 46 (8.7%) subsequent events caused stroke (p < 0.0001), while 19 (41.3%) were asymptomatic. Connective tissue abnormalities were found in 54 (56.3%) patients with monophasic and 8 (66.7%) with late recurrent dissections (p = 0.494).ConclusionTwenty-two (9.2%) patients had new CeAD events within 1 month and 17 (7.1%) later recurrences. The risk for new events was significantly higher (about 60-fold) during the acute phase than during later follow-up. Connective tissue abnormalities were not more frequent in patients with late recurrent events than in those with monophasic CeAD.

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Connective tissue and vascular phenotype in patients with cervical artery dissection

Neurology ◽

10.1212/01.wnl.0000264892.92538.a9 ◽

2007 ◽

Vol 68 (24) ◽

pp. 2120-2124 ◽

Cited By ~ 27

Author(s):

R. Dittrich ◽

A. Heidbreder ◽

D. Rohsbach ◽

J. Schmalhorst ◽

I. Nassenstein ◽

...

Keyword(s):

Connective Tissue ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Vascular Phenotype ◽

Cervical Artery

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Next generation sequencing analysis of patients with familial cervical artery dissection

European Stroke Journal ◽

10.1177/2396987317693402 ◽

2017 ◽

Vol 2 (2) ◽

pp. 137-143 ◽

Cited By ~ 11

Author(s):

Caspar Grond-Ginsbach ◽

Tobias Brandt ◽

Manja Kloss ◽

Suna Su Aksay ◽

Philipp Lyrer ◽

...

Keyword(s):

Connective Tissue ◽

Candidate Genes ◽

Allele Frequency ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Connective Tissue Disorders ◽

Single Nucleotide Variants ◽

Single Nucleotide ◽

Cervical Artery ◽

Stop Loss

Background The cause of cervical artery dissection is not well understood. We test the hypothesis that mutations in genes associated with known arterial connective tissue disorders are enriched in patients with familial cervical artery dissection. Patients and methods Patient duos from nine pedigrees with familial cervical artery dissection were analyzed by whole exome sequencing. Single nucleotide variants in a panel of 11 candidate genes (ACTA2, MYH11, FBN1, TGFBR1, TGFBR2, TGFB2, COL3A1, COL4A1, SMAD3, MYLK and SLC2A10) were prioritized according to functionality (stop-loss, nonsense, and missense variants with polyphen-2 score ≥0.95). Variants classified as “benign” or “likely benign” in the ClinVar database were excluded from further analysis. For comparison, non-benign stop-loss, nonsense and missense variants with polyphen-2 score ≥0.95 in the same panel of candidate genes were identified in the European non-Finnish population of the ExAC database ( n = 33,370). Results Non-benign Single nucleotide variants in both affected patients were identified in four of the nine cervical artery dissection families (COL3A1; Gly324Ser, FBN1: Arg2554Trp, COL4A1: Pro116Leu, and TGFBR2: Ala292Thr) yielding an allele frequency of 22.2% (4/18). In the comparison group, 1782 variants were present in 33,370 subjects from the ExAC database (allele frequency: 1782/66,740 = 2.7%; p = 0.0008; odds ratio = 14.2; 95% confidence interval = 3.8–52.9). Conclusion Cervical artery dissection families showed enrichment for non-benign variants in genes associated with arterial connective tissue disorders. The observation that findings differed across families indicates genetic heterogeneity of familial cervical artery dissection.

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