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Cervical artery dissection

Cervical artery dissection is a tear in the lining in one of the arteries in your neck. This can make you more likely to develop blood clots, which can restrict the blood supply to your brain and lead to a stroke.

Blood vessels (arteries) carry blood from your heart to various parts of your body. Two pairs of major arteries in your neck, called the carotid arteries and the vertebral arteries, carry blood to your brain. Together these are called the cervical arteries. 

In cervical artery dissection, the lining of one of the cervical arteries becomes torn. Tears happen more often in the carotid arteries than in the vertebral arteries. Blood clots can then become stuck in the tear in your artery wall, or they can break off and travel to your brain.

When the blood flow to your brain is disrupted, it can become starved of oxygen and nutrients. This damages brain cells and they begin to die. Your brain controls everything your body does, including your movement, speech, vision and emotions. Damage to your brain can affect any of these functions.

Cervical artery dissection is one of the most common causes of stroke in people under the age of 50.

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Image showing cervical artery dissection

Details

  • Symptoms Symptoms of cervical artery dissection

    The symptoms of cervical artery dissection include:

    • a severe headache
    • pain in your neck
    • a drooping eyelid
    • unequal pupils
    • difficulties swallowing
    • problems with your vision
    • feeling weak on one side of your body

    If these symptoms come on suddenly, seek emergency help immediately.

  • Diagnosis Diagnosis of cervical artery dissection

    Your GP, or doctor at the hospital, will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    You may have a number of different tests in hospital to confirm whether you had a cervical artery dissection. This may include one or more of the following.

    • A magnetic resonance (MR) angiogram uses magnets and radio waves to produce images of the blood vessels in your neck.
    • A CT angiogram combines a conventional CT scan with angiography to create detailed images of your blood vessels.
    • A Doppler ultrasound uses sound waves to produce an image of your blood vessels.

    You may also need other tests on your heart and blood vessels, including a conventional angiogram. This is a test that uses an injection of a special dye into your arteries to make them clearly visible on X-ray images.

    The results of these tests will help your doctor to plan your treatment.

  • Treatment Treatment of cervical artery dissection

    Cervical artery dissections often heal up on their own without any treatment. It usually takes about three to six months for your artery to return to normal. Any treatments you have are used to prevent complications, such as a stroke, while your artery heals.

    Medicines

    Medicines can help to prevent blood clots. They include:

    • an anticoagulant medicine such as heparin, which is given through a drip into a vein in your arm, followed by warfarin tablets
    • an antiplatelet medicine such as aspirin or clopidogrel tablets

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Surgery

    If your artery isn’t healing properly on its own, or you have more strokes despite taking medicines, your doctor may advise you to have an angioplasty and stenting procedure. In this operation, your doctor will put small tubes called stents into your artery to strengthen it and keep it open. This will help to prevent blood clots forming.

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  • Causes Causes of cervical artery dissection

    Cervical artery dissection can be caused by any kind of trauma to your neck, including:

    • high-impact injuries, such as from a car crash
    • minor neck injuries from doing sports such as judo or yoga, for example
    • neck strain from a low-impact activity such as overhead painting, for example

    You will usually get symptoms within hours or a few days of an injury happening, but rarely they can happen weeks or even months later.

    Cervical artery dissection can also be caused by having an underlying condition that leads to weakening of your blood vessels, but this is rare. Examples of these conditions include Ehlers–Danlos syndrome, fibromuscular dysplasia, Erdheim disease and Marfan syndrome.

    Cervical artery dissection can happen spontaneously, even if you don’t have any of these conditions or trauma to your neck.

  • Complications Complications of cervical artery dissection

    If you have had a cervical artery dissection, you may:

    • have another cervical artery dissection – this happens most often in people who have an underlying condition that affects their blood vessels
    • have an ischaemic stroke, which happens when the blood supply to your brain is blocked off
    • develop an aneurysm (swelling of a blood vessel) in your neck, which can cause you to have a number of strokes
  • FAQs FAQs

    Can having chiropractic cause cervical artery dissection?

    Answer

    It’s very rare that having chiropractic can cause you to have a cervical artery dissection. It may only be more likely to happen if you’re already at risk of the condition.

    Explanation

    Chiropractors treat a variety of conditions, including back, neck and shoulder pain using spinal manipulation and other manual treatments. It’s usually painless unless the affected area is inflamed (swollen), in which case your chiropractor will change your treatment.

    Although there have been some reports that spinal manipulation may trigger cervical artery dissection, it’s very unlikely to happen unless you’re already at risk of the condition. This may be from having a disorder that leads to weakening of your blood vessels, such as Ehlers–Danlos syndrome or fibromuscular dysplasia. A definite link between having chiropractic and getting a cervical artery dissection hasn't been established.

    Before you see a chiropractor, check that he or she is registered with the General Chiropractic Council.

    Why do I need to be monitored if I'm taking warfarin for cervical artery dissection?

    Answer

    Warfarin works by thinning your blood, which makes it less likely to clot. However, sometimes, your blood can become too 'thin', which can cause complications from increased bleeding. For this reason, you will need to be carefully monitored when you take warfarin.

    Explanation

    If you’re taking warfarin for cervical artery dissection, you will need to have regular blood tests to check that it isn't causing your blood to become too thin. The blood tests measure your international normalised ratio (INR), which is a measure of how quickly your blood takes to clot.

    When you first start treatment with warfarin, you will need to have your INR measured every day, or every other day. This is to help your doctor work out the best dose for you. Once your INR has become stable, you will be monitored at longer intervals.

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Can having your hair washed at the hairdresser's cause cervical artery dissection?

    Answer

    It’s very rare to have a cervical artery dissection from getting your hair washed at the hairdresser.

    Explanation

    Your hair is usually washed in a hairdresser's by hanging your head backwards over a sink. If you extend your neck back too far, there is a risk that you can damage the cervical arteries in your neck. This can potentially cause you to have a cervical artery dissection, which may result in stroke – sometimes referred to as ‘beauty parlour stroke syndrome’. However, the chances of this happening are very rare.

    With any injury to your neck, certain people may be more at risk of cervical artery dissection than others. This may include those who have an underlying condition that leads to weakening of the blood vessels, such as Ehlers–Danlos syndrome or fibromuscular dysplasia.

    Your hairdresser should be trained not to overextend your neck when he or she washes your hair. However, if you feel any discomfort when you have your hair washed, ask the hairdresser to stop and to provide extra support for your neck, such as a cushion or rolled-up towel.

  • Resources Resources

    Further information

    Sources

    • Carotid artery dissection. eMedicine. www.emedicine.medscape.com, published 10 May 2012
    • Stroke: diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). National Institute for Health and Care Excellence. www.nice.org.uk, published July 2008
    • Vertebral artery dissection. eMedicine. www.emedicine.medscape.com, published 4 March 2013
    • Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 2009;8:668–78. doi: 10.1016/S1474-4422(09)70084-5
    • Carotid artery dissection clinical presentation. eMedicine. www.emedicine.medscape.com, published 10 May 2012
    • American College of Cardiology Foundation/American Heart Association. Guideline on the management of patients with extracranial carotid and vertebral artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2011; 57(8):e16–e94. doi: 10.1016/j.jacc.2010.11.006
    • Carotid artery dissection treatment and management. eMedicine. www.emedicine.medscape.com, published 10 May 2012
    • Carotid artery dissection workup. eMedicine. www.emedicine.medscape.com, published 10 May 2012
    • CT angiography. Society for Vascular Surgery. www.vascularweb.org, published 4 September 2009
    • Vertebral artery dissection follow-up. eMedicine. www.emedicine.medscape.com, published 4 March 2013
    • Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropractic and Osteopathy 2010;18(3). doi:10.1186/1746-1340-18-3
    • What can I expect when I see a chiropractor? General Chiropractic Council. www.gcc-uk.org, published March 2010
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed April 2013
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