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Cervical artery dissection


Expert reviewer, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
New review due May 2019

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 to develop, which can affect the blood supply to your brain and lead to a stroke. Cervical artery dissection is one of the most common causes of stroke in people under the age of 50.

Anxious woman

About cervical artery dissection

Your 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. There are the two carotid arteries and the two vertebral arteries, and they carry blood to your brain. The diagram below show one of the carotid arteries and one of the vertebral ones, as the illustration is a side view.

Image showing cervical artery dissection

If you have cervical artery dissection, the wall of one of these arteries has torn. This is more likely to happen in your carotid arteries than in the vertebral arteries. Once a tear develops, blood can stick to it and grow into a clot, which can block the artery where the tear is. 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 and this damages brain cells. A stroke is a brain injury and, depending on where in your brain the stroke happens, it could affect your movement, sensation, speech, vision and thinking.

Symptoms of cervical artery dissection

The symptoms of cervical artery dissection can be vague and wide-ranging. It depends on which artery has been affected and how severely, and whether or not you have a stroke as a result.

Some of the main symptoms of cervical 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
  • swollen neck
  • fainting
  • pulsating tinnitus (a rhythmic noise that often beats in time to your heart)

If you have a stroke as a result of cervical artery dissection, you may get other symptoms . These include:

  • pain and numbness on one side of your face
  • changes in sensation in your body and limbs
  • a feeling of moving or spinning when you’re not (vertigo)
  • nausea and being sick

If these symptoms come on suddenly or happen after you’ve injured your neck, seek emergency help immediately.

Diagnosis of cervical artery dissection

Your doctor will ask about your symptoms and examine you. Your doctor will also need to know about any recent injury or activity that may have caused a tear in one of the cervical arteries.

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

  • An MRI (magnetic resonance imaging) scan or a CT scan. These create detailed images of your head and neck. Both scans are sometimes done with angiogram. During an angiogram, dye is injected into your arteries. This helps your doctor to see them in more detail.
  • An ultrasound scan of your arteries. This is a scan that uses sound waves to produce an image of your blood vessels.

Treatment of cervical artery dissection

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

Treatment for cervical artery dissection usually aims to prevent complications, such as a stroke, while your artery heals. This usually takes about three to six months.

Medicines

If you’re diagnosed and can get medical help quickly (that is, 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 is injected into a vein. This breaks up blood clots, but it can only be given in the first few hours after an injury.

You will probably be asked to take medicines to prevent blood clots. There are two main types:

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

Surgery

If you can’t take anticoagulant or antiplatelet medicines or if the medicines aren’t working, your doctor may suggest an operation. An angioplasty and stenting procedure can help to prevent blood clots forming. But this isn’t a standard option and may only be offered in rare circumstances.

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, sneezing or vomiting

There is some debate about whether chiropractic treatment can cause cervical artery dissection – please see our FAQ ‘Chiropractic treatment’ about this.

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

Viral infections are also thought to potentially 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 develop complications. Some people develop headaches, 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.

Cranial nerve palsies are also a complication of cervical artery dissection. A palsy is caused if a cranial nerve close to your carotid artery is compressed (squashed). Palsy can affect your eyes and tongue causing drooping eyelid and weakness of your tongue.

Frequently asked questions

  • Research studies looking at whether or not spinal manipulation, as in chiropractic therapy, cause cervical artery dissection haven’t found a clear answer.

    An association has been suggested between spinal manipulation and cervical artery dissection, particularly concerning the vertebral artery. But experts don’t know if it was because of the treatment or because the patient already had cervical artery dissection.

    For example, if you develop cervical artery dissection, you could develop neck pain and go to a chiropractor for treatment. Or you could develop cervical artery dissection after treatment for neck pain. This means it’s not possible to know whether the cervical artery dissection was there before treatment or whether it developed because of the treatment.

    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 are registered and ask any questions you have.

  • Warfarin prevents blood clots by increasing the time it takes the blood to clot. This is often referred to as ‘blood thinning’. However, sometimes the dose of warfarin isn’t quite right and your blood can become too 'thin'. This can cause bleeding. For this reason, you’ll need to be carefully monitored when you take warfarin.

    The monitoring is done by regular blood tests to check how quickly your blood is clotting. The tests measure INR (international normalised ratio). How often the tests are done depends on what the results are.

    Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

  • 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 might lead to cervical artery dissection. However, there are very few reported cases where this has or might have happened.


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Related information

    • Carotid artery dissection. Medscape. emedicine.medscape.com, updated September 2015
    • Biller J, Sacco R, Albuquerque F, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the American Heart Association/American Stroke Association. 2014; 45:3155–74
    • Cardiovascular system anatomy. Medscape. emedicine.medscape.com, updated August 2014
    • Overview of stroke. The MSD Manuals. www.msdmanuals.com, last full review/revision November 2013
    • Vertebral artery dissection. Medscape. emedicine.medscape.com, updated November 2015
    • Ischaemic stroke. BMJ Best Practice. bestpractice.bmj.com, last updated December 2015
    • Ischemic stroke. Medscape. emedicine.medscape.com, updated November 2015
    • Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. National Institute for Health and Care Excellence (NICE), 2008. www.nice.org.uk
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    • Magnetic resonance imaging. PatientPlus. patient.info, last checked January 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 9 March 2016
    • About the GCC. General Chiropractic Council. www.gcc-uk.org, accessed 9 March 2016
    • Warfarin. Medscape. reference.medscape.com, accessed 9 March 2016
    • Haematology. Oxford handbook clinical medicine (online). Oxford Medicine Online. oxfordmedicine.com published January 2014
    • Hanelinea M, Rosnerberg A. The etiology of cervical artery dissection. Chiropr Med. 2007 Summer; 6(3):110–20.
    • Micheli S, Paciaroni M, Corea F, et al. Cervical artery dissection: emerging risk factors. Open Neurol J 2010; 4:50–55. doi:10.2174/1874205X01004010050
    • Cranial nerve lesions. PatientPlus. www.patient.info, last checked 16 June 2014
  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, May 2016.
    Expert reviewer, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician.
    New review due May 2019.



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