Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection - 12/05/15

Doi : 10.1016/S1474-4422(15)00009-5

Stéphanie Debette, ProfMD ^a,^b,^⁎,^{^{†
Authors contributed equally}} , Annette Compter, MD ^c,^{^{†
Authors contributed equally}}, Marc-Antoine Labeyrie, MD ^d, Maarten Uyttenboogaart, MD ^e, Tina M Metso, MD ^f, Jennifer J Majersik, MD ^g, Barbara Goeggel-Simonetti, MD ^h, Stefan T Engelter, ProfMD ^i,^j, Alessandro Pezzini, MD ^k, Philippe Bijlenga, MD ^l, Andrew M Southerland, MD ^m, Olivier Naggara, MD ⁿ, Yannick Béjot, ProfMD ^o, John W Cole, MD ^p, Anne Ducros, ProfMD ^q, Giacomo Giacalone, MD ^r, Sabrina Schilling, MSc ^b, Peggy Reiner, MD ^a, Hakan Sarikaya, MD ^h,^s, Janna C Welleweerd, MD ^t, L Jaap Kappelle, ProfMD ^c, Gert Jan de Borst, MD ^t, Leo H Bonati, MD ⁱ, Simon Jung, MD ^h, Vincent Thijs, ProfMD ^u,^v,^w, Juan J Martin, MD ^x, Tobias Brandt, MD ^y, Caspar Grond-Ginsbach, PhD ^z, Manja Kloss, MD ^z, Tohru Mizutani, ProfMD ^aa, Kazuo Minematsu, ProfMD ^ab, James F Meschia, ProfMD ^ac, Vitor M Pereira, MD ^ad, Anna Bersano, MD ^ae, Emmanuel Touzé, ProfMD ^af, Philippe A Lyrer, ProfMD ⁱ, Didier Leys, ProfMD ^ag, Hugues Chabriat, ProfMD ^a, Hugh S Markus, ProfMD ^ah, Bradford B Worrall, ProfMD ^m, Stéphane Chabrier, ProfMD ^ai, Ralph Baumgartner, ProfMD ^aj, Christian Stapf, ProfMD ^a, Turgut Tatlisumak, ProfMD ^f, Marcel Arnold, ProfMD ^h, Marie-Germaine Bousser, ProfMD ^a

^a Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France

^b Inserm U897, Bordeaux University, France

^c Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands

^d Department of Neuroradiology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France

^e Departments of Neurology and Radiology, University Medical Centre Groningen, Groningen, Netherlands

^f Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland

^g Department of Neurology, University of Utah, Salt Lake City, UT, USA

^h Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland

ⁱ Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland

^j Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland

^k Department of Clinical and Experimental Sciences, Neurology Clinic, Brescia University Hospital, Brescia, Italy

^l Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland

^m Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA

ⁿ Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Center Hospitalier Sainte-Anne, DHU Neurovasc Paris Sorbonne, Paris, France

^o Department of Neurology, Dijon University Hospital, Dijon, France

^p Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA

^q Department of Neurology, Gui de Chauliac Hospital, Montpellier I University, Montpellier, France

^r Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, Milano, Italy

^s Department of Neurology, University Hospital of Zürich, Zürich, Switzerland

^t Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands

^u Department of Neurosciences, Experimental Neurology, Laboratory of Neurobiology, KU Leuven University of Leuven, Leuven, Belgium

^v VIB—Vesalius Research Center, Leuven, Belgium

^w Department of Neurology, University Hospitals Leuven, Leuven, Belgium

^x Department of Neurology, Sanatorio Allende, Cordoba, Argentina

^y Clinics for Neurologic Rehabilitation, Kliniken Schmieder, Heidelberg, Germany

^z Department of Neurology, University of Heidelberg, Heidelberg, Germany

^aa Department of Neurosurgery, Showa University, Tokyo, Japan

^ab Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan

^ac Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

^ad Division of Neuroradiology, Department of Medical Imaging, and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada

^ae Cerebrovascular Disease Unit, IRCCS Foundation C Besta Neurological Institute, Milan, Italy

^af Université Caen Basse Normandie, Inserm U919, Department of Neurology, CHU Côte de Nacre, Caen, France

^ag Department of Neurology, Lille University Hospital, Lille, France

^ah Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK

^ai French Centre for Paediatric Stroke and EA3065, Saint-Etienne University Hospital, Saint-Etienne, France

^aj NeuroCentre, Clinic Hirslanden Zürich, Zürich, Switzerland

^* Correspondence to: Prof Stéphanie Debette, INSERM U897, Bordeaux University, 33000 Bordeaux, France

Summary

Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.

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