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Predictors of delayed stroke in patients with cervical artery dissection


  • Conflict of interest: None declared.
  • Funding: The CADISP study has received funding from the Contrat de Projet Etat-Region 2007, Centre National de Genotypage, Helsinki University Central Hospital Research Fund, Academy of Finland, Helsinki University Medical Foundation, Päivikki and Sakari Sohlberg Foundation, Aarne Koskelo Foundation, Maire Taponen Foundation, Aarne and Aili Turunen Foundation, Lilly Foundation, Alfred Kordelin Foundation, Finnish Medical Foundation, Orion Farmos Foundation, Paavo Ilmari Ahvenainen Foundation, Maud Kuistila Foundation, Emil Aaltonen Foundation, Finnish Brain Foundation, Projet Hospitalier de Recherche Clinique Régional, Fondation de France, Génopôle de Lille, Adrinord, EA2691, Institut Pasteur de Lille, Inserm U744, Basel Stroke-Funds, Käthe-Zingg-Schwichtenberg-Fonds of the Swiss Academy of Medical Sciences, and Swiss Heart Foundation.



Stroke in patients with acute cervical artery dissection may be anticipated by initial transient ischemic or nonischemic symptoms.


Identifying risk factors for delayed stroke upon cervical artery dissection.


Cervical artery dissection patients from the multicenter Cervical Artery Dissection and Ischemic Stroke Patients study were classified as patients without stroke (n = 339), with stroke preceded by nonstroke symptoms (delayed stroke, n = 244), and with stroke at onset (n = 382). Demographics, clinical, and vascular findings were compared between the three groups.


Patients with delayed stroke were more likely to present with occlusive cervical artery dissection (P <0·001), multiple cervical artery dissection (P = 0·031), and vertebral artery dissection (P <0·001) than patients without stroke. No differences were observed in age, smoking, arterial hypertension, hypercholesterolemia, migraine, body mass index, infections during the last week, and trauma during the last month, but patients with delayed stroke had less often transient ischemic attack (P <0·001) and local signs (Horner syndrome and cranial nerve palsy; P <0·001).


Occlusive cervical artery dissection, multiple cervical artery dissection, and vertebral artery dissection were associated with an increased risk for delayed stroke. No other risk factors for delayed stroke were identified. Immediate cervical imaging of cervical artery dissection patients without ischemic stroke is needed to identify patients at increased risk for delayed ischemia.