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Spontaneous cerebral and cervical artery dissection: Clinical features and diagnosis

David S Liebeskind, MD
Jeffrey Saver, MD
Section Editor
Scott E Kasner, MD
Deputy Editor
John F Dashe, MD, PhD


Arterial dissections are a common cause of stroke in the young, but may occur at any age. Dissection occurs when structural integrity of the arterial wall is compromised, allowing blood to collect between layers as an intramural hematoma.

This topic will review the pathophysiology, etiology, clinical features, and diagnosis of spontaneous cerebral and cervical artery dissection. The treatment and prognosis of cervicocephalic dissection is reviewed in detail separately. (See "Spontaneous cerebral and cervical artery dissection: Treatment and prognosis".)

Other mechanisms of ischemic stroke and subarachnoid hemorrhage are discussed elsewhere. (See "Ischemic stroke in children and young adults: Etiology and clinical features" and "Etiology, classification, and epidemiology of stroke" and "Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage" and "Nonaneurysmal subarachnoid hemorrhage".)


Separation of the arterial wall layers results in dissection. A false lumen arises in the space where blood seeps into the vessel wall (figure 1). Hemorrhage may be due to an intimal tear or result from rupture or other pathology in the vasa vasorum [1,2]. Subintimal dissections cause luminal stenosis or occlusion whereas subadventitial dissections largely result in dissecting aneurysm formation (figure 2). False lumen extension back into the true lumen can form a double channel for blood flow in the artery.

Neurologic sequelae of extracranial and intracranial dissection may result from cerebral ischemia due to thromboembolism, hypoperfusion, or a combination of both. However, thromboembolism rather than hypoperfusion is considered the major cause of ischemic symptoms [3,4]. In addition, dissection and aneurysmal dilatation may cause local symptoms from compression of adjacent nerves and their feeding vessels, resulting in pain, partial oculosympathetic paresis (Horner syndrome), lower cranial neuropathies [5], or cervical nerve root involvement. Pain is thought to be caused by activation of nociceptors from distension of the vessel wall due to the hematoma [6].


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Literature review current through: Sep 2016. | This topic last updated: Sep 28, 2016.
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  1. Pannone A, Lucchetti G, Stazi G, et al. Internal carotid artery dissection in a patient with Behçet's syndrome. Ann Vasc Surg 1998; 12:463.
  2. Völker W, Dittrich R, Grewe S, et al. The outer arterial wall layers are primarily affected in spontaneous cervical artery dissection. Neurology 2011; 76:1463.
  3. Lucas C, Moulin T, Deplanque D, et al. Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 1998; 29:2646.
  4. Morel A, Naggara O, Touzé E, et al. Mechanism of ischemic infarct in spontaneous cervical artery dissection. Stroke 2012; 43:1354.
  5. Mattioni A, Paciaroni M, Sarchielli P, et al. Multiple cranial nerve palsies in a patient with internal carotid artery dissection. Eur Neurol 2007; 58:125.
  6. Arnold M, Cumurciuc R, Stapf C, et al. Pain as the only symptom of cervical artery dissection. J Neurol Neurosurg Psychiatry 2006; 77:1021.
  7. Downer J, Nadarajah M, Briggs E, et al. The location of origin of spontaneous extracranial internal carotid artery dissection is adjacent to the skull base. J Med Imaging Radiat Oncol 2014; 58:408.
  8. Chaves C, Estol C, Esnaola MM, et al. Spontaneous intracranial internal carotid artery dissection: report of 10 patients. Arch Neurol 2002; 59:977.
  9. Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006; 67:1809.
  10. Arnold M, Kappeler L, Georgiadis D, et al. Gender differences in spontaneous cervical artery dissection. Neurology 2006; 67:1050.
  11. Touzé E, Gauvrit JY, Moulin T, et al. Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology 2003; 61:1347.
  12. Hassan AE, Zacharatos H, Mohammad YM, et al. Comparison of single versus multiple spontaneous extra- and/or intracranial arterial dissection. J Stroke Cerebrovasc Dis 2013; 22:42.
  13. Arnold M, De Marchis GM, Stapf C, et al. Triple and quadruple spontaneous cervical artery dissection: presenting characteristics and long-term outcome. J Neurol Neurosurg Psychiatry 2009; 80:171.
  14. Besselmann M, Vennemann B, Lowens S, et al. Internal carotid artery dissection. Neurology 2000; 54:442.
  15. Ulbricht D, Diederich NJ, Hermanns-Lê T, et al. Cervical artery dissection: An atypical presentation with Ehlers-Danlos-like collagen pathology? Neurology 2004; 63:1708.
  16. Brandt T, Morcher M, Hausser I. Association of cervical artery dissection with connective tissue abnormalities in skin and arteries. Front Neurol Neurosci 2005; 20:16.
  17. Brandt T, Orberk E, Weber R, et al. Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology 2001; 57:24.
  18. Engelter ST, Grond-Ginsbach C, Metso TM, et al. Cervical artery dissection: trauma and other potential mechanical trigger events. Neurology 2013; 80:1950.
  19. Karnik R, Rothmund T, Bonner G, et al. Inline skating as a possible cause of consecutive bilateral vertebral artery dissection. Acta Neurol Scand 2000; 101:70.
  20. Abe A, Nishiyama Y, Kamiyama H, et al. Symptomatic middle cerebral artery dissection in a young tennis player. J Nippon Med Sch 2009; 76:209.
  21. DeBehnke DJ, Brady W. Vertebral artery dissection due to minor neck trauma. J Emerg Med 1994; 12:27.
  22. De Giorgio F, Vetrugno G, De Mercurio D, et al. 1. Dissection of the vertebral artery during a basketball game: a case report. Med Sci Law 2004; 44:80.
  23. Slankamenac P, Jesic A, Avramov P, et al. Multiple cervical artery dissection in a volleyball player. Arch Neurol 2010; 67:1024.
  24. Furtner M, Werner P, Felber S, Schmidauer C. Bilateral carotid artery dissection caused by springboard diving. Clin J Sport Med 2006; 16:76.
  25. Bartsch T, Palaschewski M, Thilo B, et al. Internal carotid artery dissection and stroke after SCUBA diving: a case report and review of the literature. J Neurol 2009; 256:1916.
  26. Skurnik YD, Sthoeger Z. Carotid artery dissection after scuba diving. Isr Med Assoc J 2005; 7:406.
  27. Gibbs JW 3rd, Piantadosi CA, Massey EW. Internal carotid artery dissection in stroke from SCUBA diving: a case report. Undersea Hyperb Med 2002; 29:167.
  28. Konno K, Kurita H, Ito N, et al. Extracranial vertebral artery dissection caused by scuba diving. J Neurol 2001; 248:816.
  29. Mayer SA, Rubin BS, Starman BJ, Byers PH. Spontaneous multivessel cervical artery dissection in a patient with a substitution of alanine for glycine (G13A) in the alpha 1 (I) chain of type I collagen. Neurology 1996; 47:552.
  30. Nelson EE. Internal carotid artery dissection associated with scuba diving. Ann Emerg Med 1995; 25:103.
  31. Faivre A, Abdelfettah Z, Rodriguez S, Nicoli F. Neurological picture. Bilateral internal carotid artery dissection due to elongated styloid processes and shaking dancing. J Neurol Neurosurg Psychiatry 2009; 80:1154.
  32. Prabhakar S, Bhatia R, Khandelwal N, et al. Vertebral artery dissection due to indirect neck trauma : an underrecognised entity. Neurol India 2001; 49:384.
  33. Caso V, Paciaroni M, Bogousslavsky J. Environmental factors and cervical artery dissection. Front Neurol Neurosci 2005; 20:44.
  34. Wechsler B, Kim H, Hunter J. Trampolines, children, and strokes. Am J Phys Med Rehabil 2001; 80:608.
  35. Burneo JG, Shatz R, Papamitsakis NI, Mitsias PD. Neuroimages: amusement park stroke. Neurology 2000; 55:564.
  36. Sheikh SI, Singhal AB. Extension of "roller coaster dissection" after tissue plasminogen activator. AJNR Am J Neuroradiol 2010; 31:E4.
  37. Schneck M, Simionescu M, Bijari A. Bilateral vertebral artery dissection possibly precipitated in delayed fashion as a result of roller coaster rides. J Stroke Cerebrovasc Dis 2008; 17:39.
  38. Blacker DJ, Wijdicks EF. A ripping roller coaster ride. Neurology 2003; 61:1255.
  39. Lascelles K, Hewes D, Ganesan V. An unexpected consequence of a roller coaster ride. J Neurol Neurosurg Psychiatry 2001; 71:704.
  40. Biousse V, Chabriat H, Amarenco P, Bousser MG. Roller-coaster-induced vertebral artery dissection. Lancet 1995; 346:767.
  41. Faivre A, Chapon F, Combaz X, Nicoli F. Internal carotid artery dissection occurring during intensive practice with Wii video sports games. Neurology 2009; 73:1242.
  42. Dharmasaroja P, Dharmasaroja P. Sports-related internal carotid artery dissection: pathogenesis and therapeutic point of view. Neurologist 2008; 14:307.
  43. Stamboulis E, Raptis G, Andrikopoulou A, et al. Spontaneous internal carotid artery dissection: an uncommon cause of recurrent postpartum headache. J Neuroimaging 2011; 21:76.
  44. Delasobera BE, Osborn SR, Davis JE. Thunderclap headache with orgasm: a case of basilar artery dissection associated with sexual intercourse. J Emerg Med 2012; 43:e43.
  45. Paciaroni M, Bogousslavsky J. Cerebrovascular complications of neck manipulation. Eur Neurol 2009; 61:112.
  46. Reuter U, Hämling M, Kavuk I, et al. Vertebral artery dissections after chiropractic neck manipulation in Germany over three years. J Neurol 2006; 253:724.
  47. Leon-Sanchez A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J 2007; 100:201.
  48. Smith WS, Johnston SC, Skalabrin EJ, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology 2003; 60:1424.
  49. Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100:330.
  50. Biller J, Sacco RL, Albuquerque FC, et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2014; 45:3155.
  51. Gouveia LO, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine (Phila Pa 1976) 2009; 34:E405.
  52. Debette S, Markus HS. The genetics of cervical artery dissection: a systematic review. Stroke 2009; 40:e459.
  53. Grond-Ginsbach C, Debette S. The association of connective tissue disorders with cervical artery dissections. Curr Mol Med 2009; 9:210.
  54. Debette S, Goeggel Simonetti B, Schilling S, et al. Familial occurrence and heritable connective tissue disorders in cervical artery dissection. Neurology 2014; 83:2023.
  55. Giossi A, Ritelli M, Costa P, et al. Connective tissue anomalies in patients with spontaneous cervical artery dissection. Neurology 2014; 83:2032.
  56. Gdynia HJ, Kühnlein P, Ludolph AC, Huber R. Connective tissue disorders in dissections of the carotid or vertebral arteries. J Clin Neurosci 2008; 15:489.
  57. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 2009; 8:668.
  58. de Bray JM, Marc G, Pautot V, et al. Fibromuscular dysplasia may herald symptomatic recurrence of cervical artery dissection. Cerebrovasc Dis 2007; 23:448.
  59. Olin JW, Froehlich J, Gu X, et al. The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation 2012; 125:3182.
  60. Olin JW, Gornik HL, Bacharach JM, et al. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048.
  61. Kadian-Dodov D, Gornik HL, Gu X, et al. Dissection and Aneurysm in Patients With Fibromuscular Dysplasia: Findings From the U.S. Registry for FMD. J Am Coll Cardiol 2016; 68:176.
  62. Rouvière S, Michelini R, Sarda P, Pagès M. Spontaneous carotid artery dissection in two siblings with osteogenesis imperfecta. Cerebrovasc Dis 2004; 17:270.
  63. Thal DR, Schober R, Schlote W. Carotid artery dissection in a young adult: cystic medial necrosis associated with an increased elastase content. Clin Neuropathol 1997; 16:180.
  64. Hegedüs K. Reticular fiber deficiency in the intracranial arteries of patients with dissecting aneurysm and review of the possible pathogenesis of previously reported cases. Eur Arch Psychiatry Neurol Sci 1985; 235:102.
  65. Weiss N, Demeret S, Sonneville R, et al. Bilateral internal carotid artery dissection in cystathionine beta-synthase deficiency. Eur Neurol 2006; 55:177.
  66. Larranaga J, Rutecki GW, Whittier FC. Spontaneous vertebral artery dissection as a complication of autosomal dominant polycystic kidney disease. Am J Kidney Dis 1995; 25:70.
  67. Vila N, Millán M, Ferrer X, et al. Levels of alpha1-antitrypsin in plasma and risk of spontaneous cervical artery dissections: a case-control study. Stroke 2003; 34:E168.
  68. Fantaneanu T, Veinot JP, Torres C, et al. Cervical arterial dissections due to segmental mediolytic arteriopathy. Neurology 2011; 77:295.
  69. Mawet J, Boukobza M, Franc J, et al. Reversible cerebral vasoconstriction syndrome and cervical artery dissection in 20 patients. Neurology 2013; 81:821.
  70. Kim BJ, Yang E, Kim NY, et al. Vascular Tortuosity May Be Associated With Cervical Artery Dissection. Stroke 2016; 47:2548.
  71. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344:898.
  72. Pepin M, Schwarze U, Superti-Furga A, Byers PH. Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med 2000; 342:673.
  73. Schievink WI, Björnsson J, Piepgras DG. Coexistence of fibromuscular dysplasia and cystic medial necrosis in a patient with Marfan's syndrome and bilateral carotid artery dissections. Stroke 1994; 25:2492.
  74. Harrer JU, Sasse A, Klötzsch C. Intimal flap in a common carotid artery in a patient with Marfan's syndrome. Ultraschall Med 2006; 27:487.
  75. Wityk RJ, Zanferrari C, Oppenheimer S. Neurovascular complications of marfan syndrome: a retrospective, hospital-based study. Stroke 2002; 33:680.
  76. Faivre L, Collod-Beroud G, Loeys BL, et al. Effect of mutation type and location on clinical outcome in 1,013 probands with Marfan syndrome or related phenotypes and FBN1 mutations: an international study. Am J Hum Genet 2007; 81:454.
  77. Pezzini A, Caso V, Zanferrari C, et al. Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study. J Neurol Neurosurg Psychiatry 2006; 77:95.
  78. Metso TM, Metso AJ, Salonen O, et al. Adult cervicocerebral artery dissection: a single-center study of 301 Finnish patients. Eur J Neurol 2009; 16:656.
  79. Guillon B, Berthet K, Benslamia L, et al. Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke 2003; 34:e79.
  80. Benninger DH, Herrmann FR, Georgiadis D, et al. Increased prevalence of hyperhomocysteinemia in cervical artery dissection causing stroke: a case-control study. Cerebrovasc Dis 2009; 27:241.
  81. Felício AC, Silva GS, dos Santos WA, et al. Spontaneous artery dissection in a patient with Human Immunodeficiency Virus (HIV) infection. Arq Neuropsiquiatr 2006; 64:306.
  82. Barbour PJ, Castaldo JE, Rae-Grant AD, et al. Internal carotid artery redundancy is significantly associated with dissection. Stroke 1994; 25:1201.
  83. Rubinstein SM, Peerdeman SM, van Tulder MW, et al. A systematic review of the risk factors for cervical artery dissection. Stroke 2005; 36:1575.
  84. Arnold M, Pannier B, Chabriat H, et al. Vascular risk factors and morphometric data in cervical artery dissection: a case-control study. J Neurol Neurosurg Psychiatry 2009; 80:232.
  85. Debette S, Metso T, Pezzini A, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation 2011; 123:1537.
  86. Raser JM, Mullen MT, Kasner SE, et al. Cervical carotid artery dissection is associated with styloid process length. Neurology 2011; 77:2061.
  87. Metso TM, Tatlisumak T, Debette S, et al. Migraine in cervical artery dissection and ischemic stroke patients. Neurology 2012; 78:1221.
  88. Rist PM, Diener HC, Kurth T, Schürks M. Migraine, migraine aura, and cervical artery dissection: a systematic review and meta-analysis. Cephalalgia 2011; 31:886.
  89. Schievink WI, Mokri B, Piepgras DG. Angiographic frequency of saccular intracranial aneurysms in patients with spontaneous cervical artery dissection. J Neurosurg 1992; 76:62.
  90. Debette S, Kamatani Y, Metso TM, et al. Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection. Nat Genet 2015; 47:78.
  91. Martin JJ, Hausser I, Lyrer P, et al. Familial cervical artery dissections: clinical, morphologic, and genetic studies. Stroke 2006; 37:2924.
  92. Schievink WI, Mokri B, Piepgras DG, Kuiper JD. Recurrent spontaneous arterial dissections: risk in familial versus nonfamilial disease. Stroke 1996; 27:622.
  93. Grond-Ginsbach C, Klima B, Weber R, et al. Exclusion mapping of the genetic predisposition for cervical artery dissections by linkage analysis. Ann Neurol 2002; 52:359.
  94. Wiest T, Hyrenbach S, Bambul P, et al. Genetic analysis of familial connective tissue alterations associated with cervical artery dissections suggests locus heterogeneity. Stroke 2006; 37:1697.
  95. Beletsky V, Nadareishvili Z, Lynch J, et al. Cervical arterial dissection: time for a therapeutic trial? Stroke 2003; 34:2856.
  96. Schievink WI, Mokri B, O'Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med 1994; 330:393.
  97. Paciaroni M, Georgiadis D, Arnold M, et al. Seasonal variability in spontaneous cervical artery dissection. J Neurol Neurosurg Psychiatry 2006; 77:677.
  98. Kim BM, Kim SH, Kim DI, et al. Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 2011; 76:1735.
  99. Debette S, Compter A, Labeyrie MA, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 2015; 14:640.
  100. Debette S, Grond-Ginsbach C, Bodenant M, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology 2011; 77:1174.
  101. Mokri B, Sundt TM Jr, Houser OW, Piepgras DG. Spontaneous dissection of the cervical internal carotid artery. Ann Neurol 1986; 19:126.
  102. Manabe H, Yonezawa K, Kato T, et al. Incidence of intracranial arterial dissection in non-emergency outpatients complaining of headache: preliminary investigation with MRI/MRA examinations. Acta Neurochir Suppl 2010; 107:41.
  103. Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology 1995; 45:1517.
  104. Mitsias P, Ramadan NM. Headache in ischemic cerebrovascular disease. Part I: Clinical features. Cephalalgia 1992; 12:269.
  105. Pelkonen O, Tikkakoski T, Luotonen J, Sotaniemi K. Pulsatile tinnitus as a symptom of cervicocephalic arterial dissection. J Laryngol Otol 2004; 118:193.
  106. Mokri B, Silbert PL, Schievink WI, Piepgras DG. Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery. Neurology 1996; 46:356.
  107. Crum B, Mokri B, Fulgham J. Spinal manifestations of vertebral artery dissection. Neurology 2000; 55:304.
  108. Wagner F, Mono ML, Köndgen H, et al. Cervical polyradiculopathy caused by vertebral artery dissection. Lancet 2013; 381:1510.
  109. Guillon B, Biousse V, Massiou H, Bousser MG. Orbital pain as an isolated sign of internal carotid artery dissection. A diagnostic pitfall. Cephalalgia 1998; 18:222.
  110. Richoz O, Scott Schutz J, Mégevand P. Pearls & Oy-sters: unusual manifestations of bilateral carotid artery dissection: deep monocular pains. Neurology 2012; 78:e16.
  111. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, et al. Ophthalmologic manifestations of internal carotid artery dissection. Am J Ophthalmol 1998; 126:565.
  112. Biousse V, Schaison M, Touboul PJ, et al. Ischemic optic neuropathy associated with internal carotid artery dissection. Arch Neurol 1998; 55:715.
  113. Arnold M, Bousser MG, Fahrni G, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006; 37:2499.
  114. Provenzale JM, Sarikaya B. Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol 2009; 193:1167.
  115. Vertinsky AT, Schwartz NE, Fischbein NJ, et al. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol 2008; 29:1753.
  116. Provenzale JM. MRI and MRA for evaluation of dissection of craniocerebral arteries: lessons from the medical literature. Emerg Radiol 2009; 16:185.
  117. Choi KD, Jo JW, Park KP, et al. Diffusion-weighted imaging of intramural hematoma in vertebral artery dissection. J Neurol Sci 2007; 253:81.
  118. Lum C, Chakraborty S, Schlossmacher M, et al. Vertebral artery dissection with a normal-appearing lumen at multisection CT angiography: the importance of identifying wall hematoma. AJNR Am J Neuroradiol 2009; 30:787.
  119. Benninger DH, Baumgartner RW. Ultrasound diagnosis of cervical artery dissection. Front Neurol Neurosci 2006; 21:70.
  120. Imray CH, Pattinson KT. Potential role for TCD-directed antiplatelet agents in symptomatic carotid artery dissection. Stroke 2006; 37:767.
  121. Sengelhoff C, Nebelsieck J, Nassenstein I, et al. Neurosonographical follow-up in patients with spontaneous cervical artery dissection. Neurol Res 2008; 30:687.
  122. Wessels T, Mosso M, Krings T, et al. Extracranial and intracranial vertebral artery dissection: long-term clinical and duplex sonographic follow-up. J Clin Ultrasound 2008; 36:472.
  123. Nebelsieck J, Sengelhoff C, Nassenstein I, et al. Sensitivity of neurovascular ultrasound for the detection of spontaneous cervical artery dissection. J Clin Neurosci 2009; 16:79.
  124. Arnold M, Baumgartner RW, Stapf C, et al. Ultrasound diagnosis of spontaneous carotid dissection with isolated Horner syndrome. Stroke 2008; 39:82.
  125. Dittrich R, Dziewas R, Ritter MA, et al. Negative ultrasound findings in patients with cervical artery dissection. Negative ultrasound in CAD. J Neurol 2006; 253:424.
  126. Bonati LH, Wetzel SG, Gandjour J, et al. Diffusion-weighted imaging in stroke attributable to internal carotid artery dissection: the significance of vessel patency. Stroke 2008; 39:483.
  127. Bachmann R, Nassenstein I, Kooijman H, et al. High-resolution magnetic resonance imaging (MRI) at 3.0 Tesla in the short-term follow-up of patients with proven cervical artery dissection. Invest Radiol 2007; 42:460.
  128. Naggara O, Touzé E, Marsico R, et al. High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection. Eur Radiol 2009; 19:2255.
  129. Silverman IE, Wityk RJ. Transient migraine-like symptoms with internal carotid artery dissection. Clin Neurol Neurosurg 1998; 100:116.