Extracranial and intracranial vertebral artery dissections: A comparison of clinical findings

• EVAD is likely to be associated with precipitating events causing mechanical stress to the neck.
• Sudden-onset headaches in elderly patients with medical co-morbidities may be indicative of IVAD.
• MRI may be useful to diagnose EVAD, especially when associated with mechanical stress.

BackgroundThe diagnostic criteria for extracranial vertebral artery dissection (VAD) have not been standardized among stroke centers. Recent studies have shown that extracranial (EVAD) and intracranial (IVAD) VAD may be different clinical entities. In this study, we reviewed clinical findings, including image findings of VAD cases, and compared these findings to EVAD and IVAD cases to highlight the clinical characteristics of EVAD.MethodsWe searched our database to identify VAD cases registered between April 2008 and October 2014. We performed retrospective chart reviews to obtain detailed clinical information and compared clinical characteristics and radiological findings between EVAD and IVAD cases.ResultsWe identified 10 patients with EVAD and 113 patients with IVAD. Clinically, patients with EVAD had initial symptoms that included significantly higher frequencies of neck pain, nausea, and vertigo, whereas medical hypertension and alcohol consumption were more commonly associated with IVAD cases. EVAD cases were also more likely to manifest as ischemic stroke. Radiologically, intramural hematomas were more commonly observed by magnetic resonance imaging (MRI) in patients with EVAD, whereas MRI and computed tomography more frequently revealed aneurysm formation in IVAD cases.ConclusionsOur data identified the clinical differences between patients with EVAD and IVAD. When relatively young patients complain of sudden-onset neck pain and/or other neurological symptoms, MRI studies may be useful to diagnose EVAD, especially when associated with mechanical stress.