Learning objectives
Describe the clinical and radiological features of intracranial arterial dissection,
emphasizing the importance of accurate diagnosis and the use of interventional radiology techniques for effective treatment.
Background
The intracranial arterial dissection (DAI) is an entity clinically important and relatively rare compared with extracranial arterial dissection,
and represents a significant etiology of stroke in young patients 1,2.
Its clinicalmanifestations can source ischemic or hemorrhagic depending on the pathophysiological mechanism.
The intracranial arteries are composed of three walls: intima,
media and adventitia,
and the internal elastic lamina anatomical boundary between the intima and media.
The constitution of the wall of arteries and intracranial arteries of the spinal canal differ histologically extracranial arteries when compared...
Imaging findings OR Procedure details
We describe the main angiographic findings of intracranial arterial dissection,
in the differents imaging methods:computed tomography,CT angiography,
magnetic resonance angiography (MRA) and digital angiography,
with review of clinical and therapeutic aspects.
Computed tomography and CT angiography:
Computed tomography (CT) without contrast can identify subarachnoid hemorrhage in cases of intramural intradural dissections,
topografar the mass effect resulting from giant pseudoaneurysm and parenchymal ischemic areas affected (Figure 8)6.
CT with contrast can show wall mural thickening crescent shaped,
eccentric stenosis of the arterial lumen and enhancement with...
Conclusion
Intracranial arterial dissectionsis a potential cause of transient neurological symptoms,
ischemic stroke and as a cause of subarachnoid hemorrhage,
seems to bemore frequent than previously thought and usually has a severe course.
CTA and MRA provides morphological details and document intraluminal blood flow and digital subtraction angiography is important in endovascular treatment.
Intracranial arterial dissectionsrequires a high level of suspicion to diagnosis and specific endovascular treatmentmodalities are required for each location to ensure long term stability and change the poor prognosis.
References
1 - Hosoya T,
Adachi M,
Yamaguchi K,
Haku T,
Kayama T,
Kato T: Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection.
Stroke 30:1083-1090,
1999.
2 - Yoshimoto Y,
Wakai S: Unruptured intracranial vertebral artery dissection: clinical course and serial radiographic imaging.
Stroke 28:370-374,
1997.
3 Kitanaka C,
Eguchi T,
Teraoka A,
Nakane M,
Hoya K: Intracranial vertebral artery dissections: Clinical,
radiological features,
and surgical considerations.
Neurosurgery 34:620- 627,
1994.
4 - Strong KC.
A study of the structure of the media of the...