Background and Purpose: Cervical artery dissection (CAD) is a common cause of ischemic stroke in younger aged subjects. Retrospective studies suggest cervical manipulative therapy (CMT) and preceding infections as extrinsic risk factors for CAD. In a case-control study, we assessed a questionnaire with 7 mild mechanical traumas as potential trigger factors for CAD, including CMT and recent infections. Patients and Methods: Forty-seven consecutive patients with CAD were compared with 47 consecutive patients of similar age with ischemic stroke due to etiologies other than CAD. Patients underwent a standardized face-to-face interview. We assessed head or neck pain and recent infection <7 days before symptom onset, as well as the following mechanical trigger factors <24 h and <7 days prior to symptom onset: (1) heavy lifting, (2) sexual intercourse, (3) mild direct or (4) indirect neck trauma, (5) jerky head movements, (6) sports activity, and (7) CMT. Results: We found no association between any single one of the above risk factors and CAD. CMT (CAD, n = 10; non-CAD, n = 5) and recent infections (CAD, n = 18; non-CAD, n = 10) were more frequent in the CAD group but failed to reach significance. However, the cumulative analysis of all mechanical trigger factors revealed a significant association of mechanical risk factors as a whole in CAD <24 h prior to symptom onset (p = 0.01). Conclusion: Mild mechanical stress, including CMT, plays a role as possible trigger factor in the pathogenesis of CAD. CMT and recent infections alone failed to reach significance during the present investigation, presumably due to the relatively small sample size of the study cohort.

Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner RW: Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry 2005;76:191–195.
Siqueira Neto JI, Santos AC, Fabio SR, Sakamoto AC: Cerebral infarction in patients aged 15 to 40 years. Stroke 1996;27:2016–2019.
Schievink WI, Mokri B, Piepgras DG: Spontaneous dissection of cervicocephalic arteries in childhood and adolescence. Neurology 1994;44:1607–1612.
Schievink WI: Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001;344:898–906.
Bogousslavsky J, Pierre P: Ischemic stroke in patients under age 45. Neurol Clin 1992;10:113–124.
Lisovoski F, Rousseaux P: Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry 1991;54:576–579.
Provenzale JM, Morgenlander JC, Gress D: Spontaneous vertebral dissection: clinical, conventional angiographic, CT, and MR findings. J Comput Assist Tomogr 1996;20:185–193.
Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, Kuhlenbaumer G, Stogbauer F, Ringelstein EB: Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003;250:1179–1184.
Bevan H, Sharma K, Bradley W: Stroke in young adults. Stroke 1990;21:382–386.
Rothwell DM, Bondy SJ, Williams JI: Chiropractic manipulation and stroke: a population-based case-control study. Stroke 2001;32:1054–1060.
Smith WS, Johnston SC, Skalabrin EJ, Weaver M, Azari P, Albers GW, Gress DR: Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology 2003;60:1424–1428.
Haneline MT, Croft AC, Frishberg BM: Association of internal carotid artery dissection and chiropractic manipulation. Neurologist 2003;9:35–44.
Grau AJ, Brandt T, Buggle F, Orberk E, Mytilineos J, Werle E, Conradt C, Krause M, Winter R, Hacke W: Association of cervical artery dissection with recent infection. Arch Neurol 1999;56:851–856.
Guillon B, Berthet K, Benslamia L, Bertrand M, Bousser MG, Tzourio C: Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke 2003;34:79–81.
Brandt T, Hausser I, Orberk E, Grau A, Hartschuh W, Anton-Lamprecht I, Hacke W: Ultrastructural connective tissue abnormalities in patients with spontaneous cervicocerebral artery dissections. Ann Neurol 1998;44:281–285.
Brandt T, Orberk E, Weber R, Werner I, Busse O, Muller BT, Wigger F, Grau A, Grond-Ginsbach C, Hausser I: Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology 2001;57:24–30.
Volker W, Besselmann M, Dittrich R, Nabavi D, Konrad C, Dziewas R, Evers S, Grewe S, Kramer SC, Bachmann R, Stogbauer F, Ringelstein EB, Kuhlenbaumer G: Generalized arteriopathy in patients with cervical artery dissection. Neurology 2005;64:1508–1513.
Lucas C, Lecroart JL, Gautier C, Leclerc X, Dauzat M, Leys D, Deklunder G: Impairment of endothelial function in patients with spontaneous cervical artery dissection: evidence for a general arterial wall disease. Cerebrovasc Dis 2004;17:170–174.
Wenban A: Response to ‘Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients [1]’ by Dziewas et al. (2003) in J Neurol 250:1179–1184. J Neurol 2005;252:97–98.
Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S: A systematic review of the risk factors for cervical artery dissection. Stroke 2005;36:1575–1580.
Leys D, Moulin T, Stojkovic T, Begey S, Chavot D; DONALD Investigators: Follow-up of patients with history of cervical artery dissection. Cerebrovasc Dis 1995;5:43–49.
Touze E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL: Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology 2003;61:1347–1351.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
Madden KP, Karanjia PN, Adams HP Jr, Clarke WR: Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment. Neurology 1995;45:1975–1979.
Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, et al: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864–870.
Peters M, Bohl J, Thomke F, Kallen KJ, Mahlzahn K, Wandel E, Meyer zum Buschenfelde KH: Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995;45:2284–2286.
Cellerier P, Georget AM: Dissection of the vertebral arteries after manipulation of the cervical spine. Apropos of a case. J Radiol 1984;65:191–196.
d’Anglejan-Chatillon J, Ribeiro V, Mas JL, Bousser MG, Laplane D: Dissection of the extracranial internal carotid artery. 62 cases. Presse Med 1990;19:661–667.
Desfontaines P, Despland PA: Dissection of the internal carotid artery: aetiology, symptomatology, clinical and neurosonological follow-up, and treatment in 60 consecutive cases. Acta Neurol Belg 1995;95:226–234.
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