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Cervical artery dissection

Expert reviewer, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
Next review due August 2024

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 your brain, and the vertebral artery supplies the back of the brain. Together, these arteries are known as cervical arteries.

Image showing cervical artery dissection

If you have a cervical artery dissection, the wall within one of these arteries tears. This is more likely to happen in your carotid arteries than in your vertebral arteries. Once the wall tears, blood can stick to it and form a clot, and 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 is blocked by a blood clot, it can cause a stroke. When you have a stroke, the blood supply to your brain is affected. This damages brain cells. Depending on where in your brain the stroke happens, it could affect your movement, sensation, speech, sight and thinking.

Causes of cervical artery dissection

There are two main causes of cervical artery dissection:

  • an injury or strain
  • a health condition that may weaken your blood vessels

But cervical artery dissection can also happen without any obvious injury or underlying health condition.

Injuries

Cervical artery dissection can be caused by a sudden movement of your neck or an injury to your neck such as:

  • a high-impact injury from a car crash, for example
  • a minor neck injury from doing sports like running, yoga or volleyball, for example
  • neck strain from activities such as painting a ceiling
  • coughing, blowing your nose or sneezing

It isn’t clear whether or not spinal manipulation (for example, during chiropractic therapy) could cause cervical artery dissection. Some studies have found a link between spinal manipulation and vertebral artery dissection. But it’s difficult to know for sure if the link is due to the treatment or a pre-existing cervical artery dissection that hadn’t been diagnosed yet. Ask your practitioner for information if you’re planning to have this treatment.

There’s also been some discussion about whether or not having your hair washed at the hairdressers is a risk. 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.

Health conditions

Cervical artery dissection can be caused by an underlying health condition such as:

  • inherited conditions – for example, Ehlers–Danlos syndrome and Marfan syndrome
  • high blood pressure
  • a medical problem with your blood vessels– for example, a condition called fibromuscular dysplasia

Symptoms of cervical artery dissection

It may be difficult to know whether or not you have cervical artery dissection because your symptoms may be vague. And symptoms can vary from person to person. They depend on how badly your artery is affected and whether or not you have a stroke afterwards. Your symptoms may also depend on whether you tear a carotid or a vertebral artery.

Some of the main symptoms of carotid artery dissection are:

  • a really bad headache
  • pain or tenderness in your neck on one side
  • pain in your face
  • pulsating tinnitus, which is a rhythmic noise in your ears that often beats in time to your heart
  • not being able to move one side of your body
  • 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

Vertebral artery dissection symptoms may be similar to those above, such as a bad headache and neck pain. But you may have other symptoms as well, including:

  • vertigo (a feeling of moving or spinning when you’re not)
  • numbness in your face
  • a hoarse voice
  • difficulty speaking or swallowing
  • not sensing pain or hot/cold temperatures on your body, arms and legs
  • 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 too. Your exact symptoms will depend on the blood vessel involved, but may include:

  • numbness and weakness one side of your body
  • difficulties with your speech
  • loss of sight in one eye
  • confusion
  • numbness on one side of your face so it droops
  • problems with coordination

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.

You may have one or more of the following tests to diagnose a cervical artery dissection.

Treatment of cervical artery dissection

Cervical artery dissection treatment can vary. The treatment you need will depend on:

  • how big the tear is
  • where the tear is
  • how quickly you can get treatment
  • 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. Your doctor will monitor you 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 they’ll inject 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. In this procedure, they’ll pull the clot out with the help of a wire and stent. You can have this done up to six hours after a stroke, although sometimes it can be done beyond this time.

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

  • antiplatelet medicines such as aspirin or clopidogrel
  • anticoagulants such as heparin and warfarin – if you have warfarin, your healthcare team will carefully monitor you to ensure it’s working as it should

How long you need to take any medicines for can vary – ask your doctor for advice.

Surgery for cervical artery dissection

Medicines usually work well, so doctors only consider surgery in very exceptional circumstances. But if 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 stent, which is a mesh tube, into a narrow or blocked artery to widen it and allow blood to flow through it. Other surgical procedures are possible but are only considered necessary on very rare occasions. Ask your doctor for information about these.

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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.

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

There’s a risk of tearing in the wall of one of your cervical arteries again, although the chances of this happening are low. It happens to about one in 100 people a year.

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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2021
    Expert reviewer, Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician
    Next review due August 2024

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