Comparison of Clinical and Anatomical Differences of Vertebral Artery Dissection between Minor Trauma and Non-trauma Causes

Chong, Yeon Hee; Ahn, Ji Yun; Oh, Bum Jin; Kim, Won; Lim, Kyoung Soo

Abstract

PURPOSE: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups.
METHODS
We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups.
RESULTS
From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge> or =2) showed no differences between the groups (p=0.540, p=0.267, respectively).
CONCLUSION
In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS> or =2) was not significantly different between the groups.