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Abstract
Objective: To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD).
Methods: In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 different populations for comparisons: 1) age- and sex-matched patients with ischemic stroke attributable to a cause other than CeAD (non–CeAD-IS), and 2) healthy subjects participating in the Cervical Artery Dissection and Ischemic Stroke Patients Study. The presence of PCT within 1 month was assessed using a standardized questionnaire. Crude odds ratios (ORs) with 95% confidence intervals (CIs) and ORs adjusted for age, sex, and center were calculated.
Results: We analyzed 1,897 participants (n = 966 with CeAD, n = 651 with non–CeAD-IS, n = 280 healthy subjects). CeAD patients had PCT in 40.5% (38.2%–44.5%) of cases, with 88% (344 of 392) classified as mild. PCT was more common in CeAD patients than in non–CeAD-IS patients (ORcrude 5.6 [95% CI 4.20–7.37], p < 0.001; ORadjusted 7.6 [95% CI 5.60–10.20], p < 0.001) or healthy subjects (ORcrude 2.8 [95% CI 2.03–3.68], p < 0.001; ORadjusted 3.7 [95% CI 2.40–5.56], p < 0.001). CeAD patients with PCT were younger and presented more often with neck pain and less often with stroke than CeAD patients without PCT. PCT was not associated with functional 3-month outcome after adjustment for age, sex, and stroke severity.
Conclusion: PCT seems to be an important environmental determinant of CeAD, but was not an independent outcome predictor. Because of the characteristics of most PCTs, the term mechanical trigger event rather than trauma may be more appropriate.
GLOSSARY
- CADISP=
- Cervical Artery Dissection and Ischemic Stroke Patients;
- CeAD=
- cervical artery dissection;
- CI=
- confidence interval;
- NIHSS=
- NIH Stroke Scale;
- non–CeAD-IS=
- ischemic stroke not caused by cervical artery dissection;
- OR=
- odds ratio;
- PCT=
- prior cervical trauma
Footnotes
↵* These authors contributed equally to this work.
CADISP Coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received August 16, 2012.
- Accepted in final form February 25, 2013.
- © 2013 American Academy of Neurology
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