MR Angiography: Intracranial Aneurysms

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MR Angiography: Intracranial Aneurysms

Cervical Artery Dissection:

Clinical Characteristics, Imaging

Features, Management Issues

Controversies in Vascular Imaging

for Secondary Stroke Prevention

John Huston III MD

Mayo Clinic


Cervical Artery Dissection

Epidemiology

2.6 – 2.9 cases per 100,000

2.5% all 1 st ischemic strokes

25% stroke in young adults

Most common 30 – 50

70% less than 50

2/3 carotid vs. 1/3 vertebral


Cervical Artery Dissection

Etiology

Trauma - spontaneous

Vasculopathy:

Fibromuscular dysplasia (15%)

Cystic medial necrosis

Connective tissue disorders:

Marfan’s syndrome

Ehler’s-Danlos syndrome

Osteogenesis imperfecta

ADPKD

Family History


Cervical Artery Dissection

Clinical Features

ICA Vert

Asymptomatic 15% 12%

HA and/or face pain 72% (70%)

Cerebral ischemia 62% 80%

typically 1-15 days

Horner’s syndrome 36%

Bruit 20%

Neck pain 18% (70%)

Cranial n. palsies 12%

Amaurosis fugax 11%


Cervical Artery Dissection

Outcome

Mortality


Cervical Artery Dissection

Imaging Features

ICA Vert

Spontaneous Traumatic

Stenosis 77% 45% 80%

Aneurysm 39% 59% 14%

Occlusion 15% 28% 11%

Resolved 52% 36% 52%

Improved 35% 18% 24%

Progressed 9% 27% 10%


30 M HA, neck pain 4 days after skiing

Blurred vision, small infarction cerebellum


39 F painting ceiling neck extended, sudden lt neck pain

Post chiropractic lt arm numb, difficulty swallowing

Jan 2011 Nov 2011


Jan 2011

June 2011

Nov 2011


41 M 2 days post MVA immediate neck pain


June 2010 November 2010


39 F SLE 2 days lf facial weakness following 1 wk migraine


4/2011 10/2011


51 M BP 200/130, HA and pulsatile tinnitus

2/2011

6/2011


43 F Sudden HA, lt weakness, vertigo and slurred speech

Noncontrast CT


39 yo with two episodes of left sided amaurosis fugax.


Cervical Artery Dissection

Management Issues

IA thrombolysis ischemia


54 F Work-up for infarction found neck mass and dissection

March 2001 Dec 2001


Cervical Artery Dissection

Conclusions

Disease of contradictions

Common cause of stroke in young

Ischemic symptoms often delayed

MRI/MRA preferred over CTA

MRI pathognomonic crescent sign

Good outcome in 85%

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