Cervical artery dissection

Published by Bupa's Health Information Team, March 2011.

This factsheet is for people who have had a cervical artery dissection, or who would like more information about it.

Cervical artery dissection happens when the lining in one of the arteries in the neck is torn. This restricts the blood supply to the brain and causes brain cells to die (a stroke). It’s one of the most common causes of stroke in people under the age of 50.

About cervical artery dissection

Blood vessels called 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 a major cause of stroke in younger people, particularly those under the age of 50. It can, however, affect anyone at any age.

Symptoms of cervical artery dissection

The symptoms of cervical artery dissection are slightly different depending on whether one of your carotid arteries (carotid artery dissection) or one of your vertebral arteries (vertebral artery dissection) has torn.

Carotid artery dissection can cause:

• a severe headache
• pain in your neck or face
• problems with your vision and/or drooping of your eyelid
• a pulsating noise in your ear – like a whooshing sound in time with your heart beat

Vertebral artery dissection can cause:

• a severe headache
• problems with speech and/or swallowing
• drooping of your eyelid
• loss of feeling down one side of your face and on the opposite side of your body
• reduced taste sensation
• hearing loss
• hiccups
• vertigo (this is the sensation that you, or things around you are spinning, even when you're still)
• problems with balance
• feeling sick and vomiting
• double vision

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

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, but this is rare

Causes of cervical artery dissection

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

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

You will usually get symptoms within hours of an injury happening, but they can follow 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.

Sometimes, it may not be clear what caused your cervical artery dissection.

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.

• Magnetic resonance (MR) angiogram. This uses magnets and radiowaves to produce images of the blood vessels in your neck.
• CT scan. This uses X-rays to make a three-dimensional image of your blood vessels.
• Doppler ultrasound. This uses sound waves to produce an image of your blood vessels.

You may also have some other tests on your heart and blood vessels, including an 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 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 stroke.

Medicines

The medicines you have will help to prevent blood clots. You may have:

• 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 on its own, or you have more strokes, your doctor may advise you to have an angioplasty and stenting procedure. In this operation, your doctor puts small tubes called stents into your artery to strengthen it and keep it open. This helps to prevent blood clots forming.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.