Synopsis
Recognise cervical artery dissection from painful local and cerebral ischaemic clues, obtain complete head-and-neck arterial imaging, and coordinate reperfusion and specialist antithrombotic treatment safely.
- Cervical artery dissection is an important cause of stroke in younger adults and can occur spontaneously or after seemingly minor neck strain, coughing, sport, trauma or manipulation.
- Internal carotid dissection classically causes unilateral head, face or neck pain with partial Horner syndrome, pulsatile tinnitus, retinal ischaemia or hemispheric TIA or stroke.
- Vertebral dissection more often causes occipital or posterior neck pain followed by vertigo, diplopia, dysarthria, ataxia, nystagmus, sensory change or other posterior circulation signs.
Key red flags
Ongoing or fluctuating focal deficit, aphasia, disabling posterior signs or reduced consciousness requires immediate acute-stroke activation and reperfusion imaging.
Investigation priorities
Demonstrate tapered stenosis, occlusion, intimal abnormality, pseudoaneurysm or mural change and assess intracranial vessels.
Management branches
New unilateral head or neck pain occurs with partial Horner syndrome, pulsatile tinnitus or lower cranial neuropathy.
- Perform urgent neurological, pupillary and cranial-nerve examination and ask about transient retinal or cerebral symptoms and recent neck stress or injury.
- Arrange same-day CTA or MRA of the head and neck rather than relying on carotid Doppler or waiting for weakness.
Key medicines
AspirinWhen antiplatelet treatment is selected, use the acute loading and subsequent daily dose specified by the stroke service, then convert to the planned maintenance regimen.
ClopidogrelUse 75 mg orally once daily for maintenance when chosen, with any loading dose and intended duration set by the acute stroke or neurovascular protocol.