Cerebral Arterial Dissections [Neurosurgery Wiki]

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====== Cerebral Arterial Dissections ======

===== Key concepts =====

● [[hemorrhage]] into the [[tunica media]] of an [[artery]]

● may be spontaneous, posttraumatic, or iatrogenic (e.g. angiography-related), may be intracranial
or extracranial

● may present with pain (usually ipsilateral H/A or carotidynia), Horner syndrome

● (in carotid dissections), TIA/stroke, or SAH

● extracranial dissections are usually treated medically (anticoagulation), intracranial dissections with
SAH are treated surgically.

===== Nomenclature =====

Some confusion has arisen because of inconsistent terminology in the literature. Although by no
means standard, Yamaura
((Yamaura A. Nontraumatic Intracranial Arterial
Dissection: Natural History, Diagnosis, and
Treatment. Contemp Neurosurg. 1994; 16:1–6
[2] Goldstein SJ. Dissecting))
has suggested the following:

▶ [[Dissection]]. Extravasation of blood between the [[tunica intima]] and media, creating luminal narrowing or
occlusion.

▶ [[Dissecting aneurysm]]. Dissection of blood between the media and [[adventitia]], or at the media,
causing aneurysmal dilatation, which may rupture into the subarachnoid space.

▶ [[Pseudoaneurysm]]. Rupture of artery with subsequent encapsulation of the extravascular hematoma,
may or may not produce luminal narrowing.