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In younger patients, the most

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common cause of stroke is carotid

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and vertebral artery dissections.

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Now, this causes 25 percent of

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ischemic stroke in young adults.

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It can be related to substantial neck

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trauma or it can be, um, related to minor

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neck trauma like coughing or sneezing.

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It's associated with arteriopathies,

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we'll go through FMD. Symptoms are usually

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ipsilateral headache and neck pain.

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Fifty percent may have

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cerebral or retinal ischemia.

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Vertebral dissection patients have posterior

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neck pain, and 89 percent have stroke.

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Not uncommonly, they have a picoteritory stroke.

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Very rarely, they have subarachnoid hemorrhage

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if the dissection extends intrapremium.

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So as far as dissection, CTA is best

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for looking at the intimal flap, the

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pseudoaneurysm, high grade stenosis,

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occlusion, and skull base fractures.

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So, CTA is the first line of imaging,

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MRI is good for looking at a subacute

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wall hematoma, which obviously you

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won't see in the acute stage, and it's

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best for identifying the infarctions.

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And so, in this case, you can see the

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patient has, um, severe stenosis and

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these small pseudoaneurysms and this

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really irregular internal carotid artery.

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On the axial image, you can see there's

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obliteration of the back plane, so

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you know there's a wall hematoma.

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And then this is just an MRI showing

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the percent of hyperintensity that you

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see in the subacute stage, but you won't

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see this when patients come in acutely,

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so it's, it's not that helpful acutely.

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So I just wanted to show two

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more cases of dissection.

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This patient had bilateral carotid dissections.

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It was a pedestrian struck by a car and you

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can see there's a fracture going through

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the internal carotid canal on the left.

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through the carotid or vertebral canals,

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there's an increased incidence of dissections.

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And this patient has the

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classic skull base dissections.

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We tend to dissect right here where

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they're going from the flexible

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neck to the rigid skull base.

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And you can see narrowing and irregularity

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and then the pseudoaneurysm on the right.

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And you see the same thing on the

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left, the pseudoaneurysm on the left.

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So that's kind of classic bad MVA, skull base

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fracture, carotid dissections at the skull base.

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Thanks.

2:24

And then, um, this is another

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patient who was in high speed MVA.

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You can see the fracture through

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the anterior arch of C one.

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And this patient has a pointed carotid that's

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occluded just distal to the bifurcation.

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It gets reconstituted higher up and has through

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an embol to the MCA and has an right MCA stroke.

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So again, increased incidence of

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dissection with fractures and a pointed

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carotid suggests an acute occlusion.