Comparison of Spontaneous Intracranial Vertebral Artery Dissection With Large Artery Disease | Traumatic Brain Injury | JAMA Neurology | JAMA Network
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Original Contribution
December 2006

Comparison of Spontaneous Intracranial Vertebral Artery Dissection With Large Artery Disease

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Lee and Yong), Neurosurgery (Dr Shin), and Neuroradiology (Drs Moon Kim and Yong Kim), Ajou University School of Medicine, Suwon, South Korea; Department of Neurology, Armed Forces Seoul Hospital (Dr Lee), and Department of Neurology, Sungkyunkwan University School of Medicine, (Dr Bang), Seoul, South Korea.

Arch Neurol. 2006;63(12):1738-1744. doi:10.1001/archneur.63.12.1738

Objective  To compare clinical and angiographic characteristics and stroke patterns between spontaneous intracranial vertebral artery dissection (VAD) and vertebral large artery disease (LAD) (atherosclerosis).

Design  Retrospective study.

Setting  Tertiary referral center for cerebrovascular diseases.

Patients  Twenty-two patients with spontaneous VAD and 25 with LAD in the intracranial portion of the vertebral artery.

Main Outcome Measures  We compared (1) clinical characteristics, including epidemiologic data, vascular risk factors including inflammatory markers, the presence of headache, and stroke syndromes and severity; (2) stroke pattern on diffusion-weighted imaging, which was classified as vertebral perforator infarct, basilar perforator infarct, small scattered infarct, large scattered infarct, and territorial infarct; and (3) angiographic findings, ie, the distribution of involved arteries, degree of stenosis, and the involvement on the anterior circulation and calcification of vertebral artery.

Results  Although patients with VAD were younger, and more often had headaches and fewer vascular risk factors than those with LAD (P<.01 in all cases), these clinical features were also observed in some LAD patients. Diffusion-weighted imaging data showed that vertebral perforator infarct and small scattered infarct were most common in the VAD group, while territorial infarct and large scattered infarct were most common in the LAD group (P = .02). On angiography, LAD more frequently had anterior circulation arterial involvement (P = .002), higher degree of stenosis (P = .002), and calcifications (P = .008).

Conclusion  Our findings indicate that results of diffusion-weighted imaging and noninvasive vascular studies might provide clues to the clinical characteristics in differential diagnosis between VAD and LAD.