Cervical artery dissection

Expert reviewer Dr Usman Khan, Consultant Neurologist
Next review due March 2022

Cervical artery dissection is a condition where you have a tear in the wall of one of the large blood vessels (arteries) in your neck. This can cause blood clots in your arteries, which can affect the blood supply to your brain. Cervical artery dissection is one of the most common causes of stroke in people under 50.

A man is stretching outdoors

About cervical artery dissection

Arteries carry blood from your heart to the rest of your body. You have two pairs of large arteries on each side of your neck, which carry blood to your brain. On each side, the carotid artery supplies the front of the brain and the vertebral artery supplies the back of the brain. These arteries are known as cervical arteries. The diagram below shows one pair of cervical arteries, as the illustration is a side view.

Image showing cervical artery dissection

The diagram also shows what happens when you have a cervical artery dissection. This is where the wall within one of the arteries tears. This is more likely to happen in your carotid arteries than in your vertebral arteries. Once a tear occurs within an artery, blood can stick to it and form a clot. This can block the artery around the tear. Or part or all of the clot can break off and block the artery further up.

If an artery becomes blocked by a blood clot, this can cause a stroke. When you have a stroke, the blood supply to your brain is affected, which then damages brain cells. Depending on where in your brain the stroke happens, it could affect your movement, sensation, speech, vision and thinking.

Symptoms of cervical artery dissection

If you have cervical artery dissection, your symptoms may be very vague. The symptoms also vary from person to person. They depend how badly your artery has been affected, and whether or not you have a stroke afterwards. Your symptoms may also depend on whether a carotid or vertebral artery is affected.

Some of the main symptoms of carotid artery dissection include:

  • a severe headache
  • pain in your face and neck
  • problems with your sight, including temporarily losing your sight completely
  • migraine symptoms, such as shimmering lights in your vision
  • a drooping eyelid, which can be very painful
  • a swollen neck
  • fainting
  • pulsating tinnitus (a rhythmic noise in your ears that often beats in time to your heart)

If you have vertebral artery dissection, you may have some similar symptoms to those above, such as a severe headache and neck pain. But you may have other symptoms as well, including:

  • face pain and numbness
  • difficulty speaking or swallowing
  • a hoarse voice
  • being unable to sense pain or hot/cold temperatures on your body, arms and legs
  • vertigo (a feeling of moving or spinning when you’re not)
  • loss of taste
  • hiccups
  • feeling, or being, sick
  • double-vision
  • hearing loss on one side
  • trouble with your balance

If you have a stroke following a cervical artery dissection, you may get other symptoms. Your exact symptoms will depend on the blood vessel involved, but may include:

  • pain and numbness on one side of your face
  • changes in sensation in your body, arms and legs
  • disturbed speech
  • vertigo
  • feeling, or being, sick
  • problems with your sight, such as a loss of vision

Some of the symptoms above can be caused by other, less serious, health problems. But if these symptoms come on suddenly or happen after you’ve hurt your neck, seek emergency help straightaway.

Diagnosis of cervical artery dissection

Your doctor will ask about your symptoms and examine you. Tell them if you’ve had any recent injuries or have taken part in any activities that may have caused a tear in one of your cervical arteries.

Several different tests can help to show a cervical artery dissection. You may have one or more of the following.

Treatment of cervical artery dissection

Cervical artery dissection can be treated in different ways. The treatment you need will depend on:

  • how big the tear is
  • where the tear is
  • how quickly you can be treated
  • if you have any complications

The treatment usually aims to prevent complications, such as a stroke, while your artery heals. This usually takes about three to six months. You’ll be monitored closely to check for possible symptoms of a stroke or any side-effects from the medicines used to prevent blood clots.

Medicines for cervical artery dissection

If you have symptoms of a stroke and you’re diagnosed quickly (within three-to-four-and-a-half hours), you may have a treatment called thrombolysis. Your doctor will give you a medicine called a fibrinolytic that’s injected into your vein. This breaks up blood clots, but it can only be given in the first few hours after an injury. If the clot is large, then after thrombolysis your doctor may suggest a thrombectomy. This is where the clot is pulled out with the help of a wire and stent and can be done up to six hours after a stroke. Some people may be able to have a mechanical thrombectomy beyond six hours.

If you don’t get help so quickly, you’ll probably be asked to take medicines to prevent blood clots. There are two main types:

  • antiplatelet medicines, such as aspirin or clopidogrel
  • anticoagulants, such as heparin and warfarin

Surgery for cervical artery dissection

Medical treatments usually work well, so surgery is only considered in very exceptional circumstances. If, for example, you can’t take anticoagulant or antiplatelet medicines or medicines aren’t working for you, your doctor may suggest an angioplasty and stenting procedure to help prevent blood clots forming. An angioplasty involves putting a balloon into a narrow or blocked artery to widen it. A stent is a mesh tube inserted into the artery so that blood can still flow through it easily once the balloon has been removed. Other surgical procedures are possible, but again are only considered necessary on very rare occasions.

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Causes of cervical artery dissection

Cervical artery dissection can be caused by sudden movement of your neck or an injury to your neck, including:

  • high-impact injuries, such as from a car crash
  • minor neck injuries, such as from doing judo or yoga
  • neck strain from activities such as overhead painting
  • stretching, coughing, nose blowing, sneezing or vomiting

It’s still unclear whether chiropractic treatment can cause cervical artery dissection. Please see our FAQ on Can chiropractors cause cervical artery dissection?

Cervical artery dissection can be caused by an underlying condition that weakens your blood vessels. This includes inherited conditions such as Ehlers–Danlos syndrome and Marfan syndrome.

Viral infections may increase the risk of cervical artery dissection.

Cervical artery dissection can also just happen without any obvious injury or underlying condition.

Complications of cervical artery dissection

If you have a cervical artery dissection, you may have complications. Some people get headaches afterwards, which can last on and off for years. Others go on to have a stroke, which can sometimes cause severe disability and be life-threatening.

Certain muscles in your face may also become week because the nerves controlling them get damaged. This is known as a palsy and may affect your eyelid – causing it to become droopy – and your tongue.

Any head and neck pain after cervical artery dissection usually settles after a few weeks, but it’s possible that it may go on for months and rarely sometimes even years.

Frequently asked questions

  • It isn’t clear whether spinal manipulation (such as during chiropractic therapy) could cause cervical artery dissection. Some experts have found an association between spinal manipulation and cervical artery dissection (especially involving the vertebral artery). But they don’t know for sure if it’s because of the treatment or because of a cervical artery dissection that hadn’t yet been diagnosed.

    Cervical artery dissection can be caused by any sudden movement of your neck. It can also happen if you injure your neck. The symptoms can be very vague, so you may not realise there’s a problem with your cervical arteries at first. If your neck pain comes on suddenly, is very bad or isn’t getting better, you should go to your GP to discuss suitable treatments.

    Some people have been known to develop a cervical artery dissection after they’ve been treated for neck pain (including by a chiropractor). So, if you have sudden or severe neck pain after a chiropractic appointment, go to A&E straightaway.

    Chiropractic treatment is regulated by law. Chiropractors must be properly trained and registered with the General Chiropractic Council. Before you have any treatment with a chiropractor, check that they’re registered and ask any questions.

  • Warfarin prevents blood clots by increasing the time it takes your blood to clot. If your dose of warfarin isn’t quite right, this can cause bleeding, which can be dangerous to your health. So, you need to be carefully monitored when you take warfarin. You’ll have regular blood tests to check how quickly your blood is clotting.

    Your GP should give you specific instructions and a booklet telling you everything you need to know. At first, your blood may need to be tested every day or every other day. After a while, you may be tested at longer intervals, maybe eventually up to 12 weeks apart. You may be able to monitor your own blood clotting time at home using self-testing kits – speak to your GP about this.

  • Cervical artery dissection can sometimes be caused by small injuries, such as a sudden movement in your neck or having your neck in an unusual position. So, lying back with your neck resting on a sink at the hairdressers could possibly cause an injury that may lead to cervical artery dissection. But there are very few reported cases where this has or may have happened.

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  • Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, March 2019
    Expert reviewer Dr Usman Khan, Consultant Neurologist
    Next review due March 2022