General information
- Cervical arterial dissections are a subset of cervical cerebrovascular injuries as shown below.
- Cervical cerebrovascular injuries can be due to:
- Penetrating injury
- Traumatic dissection: the subject of this chapter
- Due to blunt trauma
- Due to stretching: e.g. from neck hyperextension or therapeutic spinal manipulation
- Iatrogenic: dissection caused by intimal tear from angiography catheters
- Traumatic compression or occlusion
- Kinking from malalignment: e.g. with cervical fracture-dislocation
- Compression by bone fragments: e.g. by fractures through foramen transversarium
Mechanism for dissection
- Dissections are initiated with a tear on the innermost intimal layer or the media layer of the blood vessel wall → Extravasation of arterial blood under pressure can extend the dissection between intima and tunica media creating luminal narrowing or occlusion → intramural hematoma → luminal stenosis → Reduced distal flow
- Dissection within the intracranial cavity → aneurysmal dilatation → haemorrhage into subarachnoid space.
- Rupture of an artery with subsequent encapsulation of the extravascular hematoma may or may not produce luminal narrowing
- Distal embolization occurs due to
- Platelet aggregation stimulated by exposed surfaces or dislodged thrombus.
Made with Bullet