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Bassi P, Lattuada P, Gomitoni A. Cervical cerebral artery dissection: a multicenter prospective study (preliminary report). Neurol Sci. 2003;24(suppl 1):S4-S7.

Forty-nine cases of dissection of the internal carotid and vertebral arteries are reported in our prospective multicenter study of 35 men and 14 women, with a mean age of 46.77 years. (range 17-60 years). We evaluated etiology, clinical manifestations, investigative techniques, and treatment. Thirty-one patients had so-called spontaneous dissections, although in the remaining 18 minimal or obvious trauma was considered as the etiological factor. Headache and neck pain occurred in 32 patients (65.3%). Local neurological manifestations were present in 15 patients (30.6%) and ischemic cerebral symptoms were present in 41 patients (83.6%). The most-relevant of the diagnostic tools are duplex sonography, magnetic resonance angiography, and angiography. Anticoagulation with heparin followed by warfarin was the treatment of choice in most of our patients. Complete recovery is reported in 14 patients (28.5%); 41 patients showed cerebral ischemic symptoms, of which 13 (26.5%) had good functional recovery. In 28 (57.1%), the NIHSS score decreased from 6.68 to 3.31 during hospitalization.

Comments.—This study provides important epidemiologic data, but the question of whether appropriate treatment is anticoagulation or antiplatelet therapy remains to be answered in a prospective, comparison, controlled study. SJT

The potential adverse impact of anticoagulation is not addressed in this study, and given that only approximately 27% of patients showed ischemic symptoms, it would be interesting to calculate a number needed to treat ([NNT] or 1/therapeutic gain) versus a number needed to harm ([NNH] or 1/therapeutic penalty) in this study. I agree with Stew that a randomized clinical trial would be helpful. DSM
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Document Type: Research Article

Publication date: April 1, 2004

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