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P154 Background Cervical arterial dissections are one  of the leading causes of stroke in the young. Role of trauma in the  pathophysiology of dissection is underestimated, especially since  neurological presentation may be delayed and traumatic cases are often  judged as “spontaneous”. Role of genetic predisposition is unclear.Methods The Canadian Stroke Consortium is presently  conducting a prospective national study of arterial cervical  dissections. We are collecting data on the mechanism of dissection  (spontaneous or traumatic) and therapeutic strategies. All cases have  angiographic confirmation.Results In 94 patients so far  (m/f:52/42;mean age 43.2,range 16–87) there were 62 vertebral artery  (VA) and 32 carotid artery (CA) dissections. “Violent” trauma  (e.g.neck manipulation) caused 20 dissections in VA and 6 in CA group.  Trivial trauma (e.g.various head turns, heavy lifting, etc.) included  32 cases in VA and 12 in CA group. The median time between trauma and  clinical presentation was 24 hours (minutes-49 days in VA and  minutes-25 days in CA group). Fibromuscular dysplasia or Marfan’s  syndrome were observed in 14 patients. There were 6 (10%) cases of  recurrent episodes in VA group vs. 5(16%) in carotid [12% overall]  despite pharmaceutical intervention before discharge. The severity  varied from TIAs to devastating strokes.Conclusions The  majority of cervical arterial dissections are traumatic. Careful  history taking is essential in deciding the mechanism of dissection.  Neurological symptoms may occur within months after trauma due to the  permanent vascular damage consequent to dissection. Detailed assessment  of underlying vascular structural fragility is needed to define  patients at risk.

Cervical Arterial Dissection:Is It Always Traumatic?