Intracranial Arterial Dissection

Introduction: Intracranial dissections (ID) were once considered to be rare. Nevertheless, they cause 5 to 20% of ischemic strokes in children and young adults. Even nowadays in Uruguay, angiography is not frequently performed in patients with evidence of ischemic vascular disorders. Consequently, the available data may underestimate its real prevalence. Materials and methods: Cohort study including all patients who were diagnosed with arterial dissection, using digital angiography, in a period of 10 years, from August 2000 to August 2010. A total of 69 patients, ages 2 to 69, with and without history of trauma were included. The clinical presentation was subarachnoid hemorrhage (SAH) and / or brain ischemia. The average follow-up was 2 years. Results: From 69 cases, 20 were children under 15 year-old, and 49 were over 15 year-old. Patients presented with ischaemic stroke in 35 cases, and hemorrhagic stroke in 34. Thirty seven patients (54%) presented arterial dissections of the posterior circulation. It should be noted that the clinical presentation for posterior fossa dissections was mostly subarachnoid hemorrhage (SAH) (67%). On the contrary, the anterior circulation showed a large majority of ischemic strokes (72%) compared with SAH (28%). Subsequently, 31 dissecting aneurysm were diagnosed and treated, using different endovascular techniques. Of the 31 cases which were treated 4 died (14%) after treatment related to the underlying pathology, 18 (56%) had good evolution of symptoms, and 10 (30%) developed some kind of neurologic impairment. Conclusions: Endovascular treatment is the treatment of choice for dissecting aneurysms, being an effective and safe treatment. In cases of dissection without SAH or dissecting aneurysms, treatment of choice is medical treatment with anticoagulation.