Cervical Artery Dissection

Cervical Artery Dissection: The Elusive Diagnosis

emDocs - April 14, 2020 - By Riggins J and Sinert R 

Reviewed by: Koyfman A and Long B

"Pearls/Pitfalls:

1. CAD is a disease process with multiple risk factors. Make sure to keep this diagnosis on your differential for any patient with severe neck pain, new-onset headache and/or neurological abnormalities on exam. Pain may be the only presenting symptom for a cervical artery dissection.
2. Although conventional angiography is the gold standard, both CTA and MRA can be used for the diagnosis of CAD. Consider using CTA over MRA if concern for vertebral artery dissection.
3. If your patient has concerning findings for CAD with negative CTA and/or MRA results, DO NOT stop your work-up. Proceed to conventional angiography (gold standard).
4. There is no difference in efficacy between anti-platelet and anticoagulation therapy in patients with symptomatic CAD (CADISS trial).
5. Accepted treatment duration is 3-6 months although the optimal duration is unclear. Repeat vascular imaging is required"