Dissection of the Cervico-Cerebral Arteries – Ultrasonographic Characteristics

Background: Dissection of the cervical and cerebral arteries represents the leading cause of non-atherosclerotic stroke in young adults. The diagnosis can be difficult as the presentation may be variable. The ultrasound (US) examination is the first diagnostic procedure, because is non invasive and informative.
The aim of this study was to analyse the ultrasonographical characteristics of the cervico-cerebral artery dissections (CCAD).
Patients and methods: We analyzed 8 consecutive cases of CCAD examined in the Ultrasound Laboratory of Neurology Clinic I from Tîrgu Mureş, Romania over a 3-year period. The mean age of the patients was 39.5±12.1 (min. 24, max. 60), the male/female ratio: 1.
Results: In 5 cases the diagnosis was established based on the ultrasound findings, in 2 cases was confirmed by angiography and in one case by MRI angiography. In 3 cases the CCAD occurred at the level of the proximal internal carotid artery (ICA), in 2 cases at distal ICA, in one case the common carotid artery, in 1-1 cases the proximal and distal part of the vertebral arteries. The most frequent ultrasound finding suggestive for CCAD was the hypoechogenic wall haematoma (3 cases). The hyperechogenic intimal flap occurred in 2 cases, the classical double lumen only in one case. In three cases the ultrasound examination revealed only indirect signs of occlusion. In one case the ultrasound findings were not suggestive for ICA dissection, the diagnosis was confirmed based on the angiography findings.
Conclusions: Color duplex ultrasound examination is an important diagnostic method in the diagnosis of CCAD with good sensitivity and specificity. The most frequent ultrasound finding in CCAD is the hypoechogenic mural haematoma. In patients with suspected CAD and negative US, repeated US examinations and further diagnostic imaging, as angiography, MRI, MRI angiography must be performed.