May 21, 2013; 80 (21) Article
Cervical artery dissection
Trauma and other potential mechanical trigger events
Stefan T. Engelter, Caspar Grond-Ginsbach, Tiina M. Metso, Antti J. Metso, Manja Kloss, Stephanie Debette, Didier Leys, Armin Grau, Jean Dallongeville, Marie Bodenant, Yves Samson, Valeria Caso, Alessandro Pezzini, Leo H. Bonati, Vincent Thijs, Henrik Gensicke, Juan J. Martin, Anna Bersano, Emmanuel Touzé, Turgut Tatlisumak, Philippe A. Lyrer, Tobias Brandt, For the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Study Group
First published May 1, 2013, DOI: https://doi.org/10.1212/WNL.0b013e318293e2eb
Stefan T. Engelter
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Caspar Grond-Ginsbach
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Tiina M. Metso
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Antti J. Metso
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Manja Kloss
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Stephanie Debette
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Didier Leys
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Armin Grau
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Jean Dallongeville
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Marie Bodenant
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Yves Samson
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Valeria Caso
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Alessandro Pezzini
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Leo H. Bonati
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Vincent Thijs
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Henrik Gensicke
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Juan J. Martin
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Anna Bersano
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Emmanuel Touzé
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Turgut Tatlisumak
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Philippe A. Lyrer
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Tobias Brandt
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
From the Department of Neurology (S.T.E., L.H.B., H.G., P.A.L.), Basel University Hospital, Basel, Switzerland; Department of Neurology (C.G.-G., M.K., T.B.), Heidelberg University Hospital, Heidelberg, Germany; Department of Neurology (T.M.M., A.J.M., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Neurology (S.D., D.L., M.B.), University Lille Nord de France, Lille, France; Neurological Clinic Ludwigshafen (A.G.), Ludwigshafen, Germany; Department of Epidemiology and Public Health (J.D.), Inserm U744, Pasteur Institute, Lille; Department of Neurology (Y.S.), Pitié-Salpêtrière University Hospital APHP, Paris, France; Stroke Unit (V.C.), Perugia University Hospital, Perugia; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Brescia, Italy; Department of Neurology (V.T.), Leuven University Hospital, and Vesalius Research Center, VIB, Leuven, Belgium; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Cerebrovascular Unit (A.B.), IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan, Italy; Paris Descartes University (E.T.), INSERM UMR S894, Department of Neurology, Sainte-Anne Hospital, Paris, France; and Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany.
Cervical artery dissection
Trauma and other potential mechanical trigger events
Stefan T. Engelter, Caspar Grond-Ginsbach, Tiina M. Metso, Antti J. Metso, Manja Kloss, Stephanie Debette, Didier Leys, Armin Grau, Jean Dallongeville, Marie Bodenant, Yves Samson, Valeria Caso, Alessandro Pezzini, Leo H. Bonati, Vincent Thijs, Henrik Gensicke, Juan J. Martin, Anna Bersano, Emmanuel Touzé, Turgut Tatlisumak, Philippe A. Lyrer, Tobias Brandt, For the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Study Group
Neurology May 2013, 80 (21) 1950-1957; DOI: 10.1212/WNL.0b013e318293e2eb
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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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