[Diagnosis and outcome of cervical artery dissection].

INTRODUCTION Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascular disease of unknown aetiology and unclear pathogenesis that may be a cause of ischemic stroke in young adults. DIAGNOSIS Precise diagnosis of dissection of the cervical artery--carotid or vertebral--is possible with cervical axial magnetic resonance imaging and magnetic resonance angiography. TREATMENT The recommended treatment in the acute phase of cervical artery dissection is anticoagulant or antithrombotic therapy, aimed at preventing a primary or recurrent ischemic event. There have been as yet no results of randomized controlled studies comparing efficacy of both treatments. An ongoing randomized multicentre study is expected to provide answers about the effects of these treatments in cervical artery dissection. OUTCOME Complete resolution of arterial abnormalities is achieved in around 46% of stenoses. 33% of occlusions, and 12% of dissecting aneurysms. RECURRENT EVENTS: Recurrence of cerebral ischemia and cervical artery dissection seems to be rare, although some data suggest that early ischemic and late cervical artery dissection recurrences could be underestimated. MORTALITY AND FUNCTIONAL OUTCOME: In comparison with other causes of stroke in young adults, the functional outcome of cervical artery dissection is good in contrast to its socio-professional effects, which may be unsatisfactory. The mortality rate of cervical artery dissection is low, although it may be underestimated since some patients with malignant infarction die before the diagnosis is established. CONCLUSION Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.