Pitfalls

The main pitfall in managing cervical artery dissection is not suspecting it in the first place.

If not initially suspected on purely clinical grounds, cervical artery dissection should be considered in any patient following head or neck injury who has persistent neurological symptoms and/or signs with a normal CT brain scan.

Cervical artery dissection can present as an acute stroke, with focal neurological signs, but no other associated features, often in a young patient.

Some such patients will meet the criteria for stroke thrombolysis.

The clinical trials of thrombolysis in acute stroke did not attempt to differentiate cervical artery dissection patients from those with other causes of stroke. Therefore, if the clinical picture is of a stroke in a young patient, but there are no other clinical features to suggest a dissection, it is reasonable to proceed with thrombolysis.

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