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Title: Cervical artery dissection in patients ≥60 years: often painless, few mechanical triggers
Austin Authors: Traenka, Christopher;Dougoud, Daphne;Simonetti, Barbara Goeggel;Metso, Tiina M;Debette, Stephanie;Pezzini, Alessandro;Kloss, Manja;Grond-Ginsbach, Caspar;Majersik, Jennifer J;Worrall, Bradford B;Leys, Didier;Baumgartner, Ralf;Caso, Valeria;Bejot, Yannick;Compter, Annette;Reiner, Peggy;Thijs, Vincent;Southerland, Andrew M;Bersano, Anna;Brandt, Tobias;Gensicke, Henrik;Touze, Emmanuel;Martin, Juan J;Chabriat, Hugues;Tatlisumak, Turgut;Lyrer, Philippe;Arnold, Marcel;Engelter, Stefan T;CADISP-Plus Study Group
Affiliation: Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland
Department of Neurology, University Hospital Berne, Berne, Switzerland
Ospedale San Giovanni, Bellinzona, Switzerland
Department of Neurology, Helsinki University Central Hospital, Finland
Department of Neurology, Bordeaux University Hospital, Bordeaux, France
Inserm U1219, Bordeaux
Bordeaux University, Bordeaux, France
Department of Neurology, Boston University School of Medicine, Boston, MA, USA
Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
Department of Neurology, University of Utah, Salt Lake City, UT, USA
Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA, USA
Univ Lille 2, INSERM U 1171, CHU Lille, France
Neuro Center, Clinic Hirslanden, Zurich, Switzerland
Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Italy
Centre Hospitalier Universitaire Le Bocage, Dijon, France
Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands
Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, France
Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Cerebrovascular Unit, IRCCS Foundation C. Besta Neurological Institute, Milan, Italy
Clinics for Neurologic Rehabilitation, Kliniken Schmieder, Heidelberg, Germany
Normandie Univ, UNICAEN, Inserm U919, Department of Neurology, CHU Caen, France
Department of Neurology, CH Sainte-Anne, University Paris Descartes, France
Department of Neurology, Sanatorio Allende, Cordoba, Argentina
Department of Neurology, Sahlgrenska University Hospital and Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden
Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland
Issue Date: 4-Apr-2017
Date: 2017-04-04
Publication information: Neurology 2017; 88(14): 1313-1320
Abstract: OBJECTIVE: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years. METHODS: We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. RESULTS: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0-2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]). CONCLUSION: In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
DOI: 10.1212/WNL.0000000000003788
Journal: Neurology
PubMed URL:
Type: Journal Article
Subjects: Neck Pain
Vertebral Artery Dissection
Appears in Collections:Journal articles

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