1) The document discusses the relationship between headaches and cervical artery dissection, noting that headaches are a common presenting symptom of dissections. 2) It reports that studies have found migraine is more common in patients who experience spontaneous cervical artery dissections compared to other stroke patients. 3) The mechanism by which migraine may increase the risk of dissection is unknown but possibly involves changes to the extracellular matrix and carotid artery distensibility.

1. Cefalea e Malattia Cerebrovascolare Roma, 25 marzo 2011 CEFALEA E DISSECAZIONE ARTERIOSA M. Silvestrini Clinica Neurologica – Dip. di Neuroscienze Università Politecnica delle Marche

3. Cefalea Cefalea associata Relazione tra Cefalea e Ictus dissecazione arteriosa

7. DISSEZIONE CAROTIDEA ematoma subintimale - ematoma subavventiziale Risk factors : mechanical injury (e.g., trauma involving the neck) during vigorous neck turning in previously diseased carotid arteries, the chance of a dissection is increased collagenopathies

9. SCENARIO: cefalea recente da dissecazione carotidea Recenti studi che si avvalgono della ecografia in fase acuta suggeriscono che questa patologia è piu’ frequente di quanto si pensasse

10. EPIDEMIOLOGIA 0.4-2.5% STROKE (< 40 anni ) INCIDENZA MEDIA: 2-3% per 100.000 (ICA) 1-1.5% per 100.000 (VA) PRESENTAZIONE: CLASSICA TRIADE: CEFALEA OMOLATERALE DOLORE FACCIALE O CERVICALE Sindrome di Horner parziale (miosi-ptosi da interruzione fibre simpatiche post-gangliari) TIA/STROKE Compressione locale IX, X, XII n.c. ESA (più comune nella dissezione vertebrale intracranica)

11. ..once you suspect cerebral artery dissection, there is a way to make an accurate diagnosis with the helps of MRI, MRA, and three-dimensional CT to demonstrate pathognomonic findings such as irregular narrowing, pearl and string sign, intramural hematoma, or a double lumen of the affected cerebral vessel. McCombe J, 2006 Median time from onset of headache to neurological symptoms: 4 days for carotid dissection 14.5 hours for VA dissection

13. FISIOPATOLOGIA DELLE COMPLICANZE ISCHEMICHE CEREBRALI Tia/ictus DISTURBO EMODINAMICO (stenosi)? EMBOLIA? TRATTAMENTO?

14. TRATTAMENTO

15. E’ sempre la stessa malattia? Cosa influenza la prognosi?

16. Distribution of the number of patent collateral vessels by mRS score. Silvestrini M et al. 2011 EARLY ACTIVATION OF INTRACRANIAL COLLATERAL VESSELS INFLUENCES THE OUTCOME OF SPONTANEOUS INTERNAL CAROTID ARTERY DISSECTION …… the possibility of selecting those patients at highest risk of an unfavorable outcome could contribute to identifying those who might benefit most from endovascular recanalization procedures.