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Clinical Issue: Craniocervical dissections are among the most common causes of stroke in people aged under 50 years, which is why it is essential to clarify, diagnose, and treat them as quickly as possible. Dissections usually occur spontaneously due to bleeding into the vessel wall. The affected segments are usually the motion segments of the internal cerebral artery (C1 segment) and the vertebral artery (V3 segment). Clinically, there is head and/or neck pain and neurologic symptoms, which can vary according to the localization of the dissection., Practical Recommendations: Pathognomonic is the detection of an intramural hematoma due to bleeding into the vessel wall. This can best be detected by magnetic resonance imaging (MRI) in native, fat-saturated T1 sequences (black-blood sequence). In addition, contrast-enhanced angiography should be performed using MRI or, alternatively, computed tomography (CT). As there is an increased risk of embolic or hemodynamically induced strokes, prophylactic treatment should be initiated immediately; it remains a case-by-case decision whether antiplatelet agents or oral anticoagulants are chosen for this purpose., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Manipulative therapy of the cervical spine is associated with a considerable risk of stroke. We evaluated all cases with the diagnosis of arterial dissection submitted between 1996 and 2005 to the Schlichtungsstelle für Arzthaftpflichtfragen der Norddeutschen Arztekammern for assessment of the accusations brought against the therapists who conducted the manipulation. Neither in the 7 carotid nor in the 9 vertebral artery cases could a causal link be made between the dissection and the manipulation. However, in 5 of the 7 carotid and 7 of the 9 vertebral artery dissections there was clear evidence or high probability that the dissection was present prior to the manipulation, and had caused neck pain, segmental dysfunction and, in some cases, even neurological symptoms. Stroke after manipulative therapy was due to embolisation of thrombotic material from the dissected artery. As both cervical arterial dissection and cervical spine disorder usually cause similar signs and symptoms physicians must differentiate between these two entities prior to any manipulative therapy. Clinical indicators of pre-existent dissection and the medicolegal implications are discussed in this paper.

Every symptom and complaint can be of psychogenic origin. In order to tell apart an organic disease from a psychogenic disturbance one has to look for objective findings, which correlate with the symptoms. Cases are presented, which illustrate psychogenic disorders, but also cases, which seem to be psychogenic but in fact are of organic origin.

In most cases the definite diagnosis of neuralgic amyotrophy is not possible, so it is based on the typical course of symptoms after other diagnoses have been excluded. We report an otherwise healthy woman who presented with symptoms typical of neuralgic amyotrophy. However we could diagnose a vertebral artery dissection that probably caused the symptoms by compression of the cervical roots. The differential diagnosis of neuralgic amyotrophy and vertebral artery dissection is discussed.

A 51-year-old woman suffering from vertigo presented to our cerebrovascular laboratory. MRI revealed a right-sided cerebellar infarction. On ultrasound examination, we found a dissection with wall hematoma of the right subclavian artery extending to the first segment of the vertebral artery and to the thyrocervical trunc, as well as a dissection of the left vertebral artery in the cranio-cervical junction. On follow-up evaluation, all stenoses resulting from dissection were recanalized within 2 months and findings of wall hematoma disappeared completely within 7 months. There was no evidence of a traumatic or iatrogenic cause of dissection; an aortic dissection was excluded by MRI. So we diagnosed a spontaneous dissection of the subclavian artery--an extremely rare but apparently existing vascular condition.