Vertebral Artery Dissection

New subarachnoid hemorrhage study results reported from Tokyo Women's Medical University, Medical Department

"This study included 58 medicolegal autopsy cases of ruptured intracranial VA dissection among 553 fatal nontraumatic cases of SAH that occurred between January 2000 and December 2007. Their clinical features were obtained from autopsy records. Histopathological investigations were performed on cross-sections obtained from all 4-mm segments of whole bilateral intracranial VAs and prepared with H & E and elastica van Gieson staining. The autopsy cases included 47 males and I I females, showing a marked predilection for males. The mean age was 46.8 +/- 7.7 years, with 78% of the patients in their 40s or 50s. Hypertension was the most frequently encountered history: it was found in 36% of cases from clinical history and in 55% of cases based on autopsy findings. Prodromal symptoms related to intracranial VA dissections were detected in 43% of patients. Headache or neck pail) lasting hours to weeks was a frequent complaint. Of patients with prodromal symptoms, 44% had consulted doctors: however, in none of these was SAH or intracranial VA dissection diagnosed at a preventable stage. Autopsy revealed fusiform aneurysms with medial dissecting hematomas. Apart from ruptured intracranial VA dissection, previous intracranial VA dissection was detected in 25 cases (43%); among them, 10 showed previous dissection of the bilateral intracranial VAs. The incidence of prodromal symptoms (60%) among the patients with previous intracranial VA dissection was significantly higher than that (30%) among cases without previous dissection (chi-square test: p = 0.023). Most previous intracranial VA dissections formed a single lumen resembling nonspecific atherosclerotic lesions, with the exception of 3 cases (12%) with a double lumen. Intracranial VA dissection resulting in fatal SAH frequently affects middle-aged men with untreated hypertension. Related to the high frequency of prodromal symptoms, latent previous intracranial VA dissection was histopathologically detected. Furthermore, intracranial VA dissection tends to induce multiple lesions affecting both intracranial VAs recurrently. This suggests the importance of an awareness of sustained whole intracranial VA vulnerability for the prevention of recurrence. The incidence of prodromal symptoms was significantly higher among patients with previous intracranial VA dissections," wrote A. Ro and colleagues, Tokyo Women's Medical University, Medical Department.

The researchers concluded: "Thus, earlier diagnosis of intracranial VA dissections at the unruptured stage is desirable for prophylaxis against fatal SAH. (DOI: 10.3171/2008.11.JNS08951)'."

Ro and colleagues published their study in the Journal of Neurosurgery (Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective. Journal of Neurosurgery, 2009;110(5):948-954).

For more information, contact A. Ro, Tokyo Women's Medical University, Faculty Medical, Dept. of Legal Medical, Shinjuku Ku, 8-1 Kawada Cho, Tokyo 1628666, Japan.

Publisher contact information for the Journal of Neurosurgery is: American Association Neurological Surgeons, 5550 Meadowbrook Drive, Rolling Meadows, IL 60008, USA.

Keywords: Japan, Tokyo, Angiology, Autopsy, Diagnostics, Headache, Hypertension, Neurology, Neurosurgery, Pathology, Subarachnoid Hemorrhage, Surgery, Vertebral Artery Dissection, Tokyo Women's Medical University, Medical Department.

This article was prepared by Pain & Central Nervous System Week editors from staff and other reports. Copyright 2009, Pain & Central Nervous System Week via NewsRx.com.