Is frequent ultrasound monitoring of spontaneous cervical artery dissection clinically useful?

Spontaneous cervical artery dissection (sCAD) is an important cause of stroke and transient ischemic attacks in young and middle-aged patients. Although spontaneous dissections of the carotid or the vertebral arteries account for only about 2% of all ischemic strokes, sCAD accounts for 10% to 25% of ischemic strokes in young patients.¹ The pathogenesis of sCAD is often unclear. An underlying arteriopathy has been accepted as a possible cause, with trivial trauma including coughing, sneezing, or vomiting,² and infections as possible other etiologies.³ A family history of arterial dissection, genetically determined alterations of the extracellular matrix, hyperhomocysteinemia, and the 677TT genotype of the 5,10-methylenetetrahydrofolate reductase gene may be important predisposing factors. However, these preexisting abnormalities do not explain all the pathophysiologic features of sCAD.⁴

Accurate diagnosis of sCAD and monitoring of its progression are crucial for adjusting medical management and affecting overall disease outcomes. Imaging plays a major role in diagnosis and follow-up of patients with sCAD. Radiologic hallmarks of sCAD include a luminal flap, a false lumen, the presence of a mural hematoma or a long tapered stenosis/occlusion, or a dissecting aneurysm.⁵ Neurosonology techniques, particularly the …