This Little-Known Cause of Strokes Has Increased 400% Since 2005

• Improved Diagnostic Techniques: Advances in neuroimaging, such as magnetic resonance angiography (MRA) and computed tomography angiography (CTA), have made it easier to detect arterial dissections that were previously missed.
• Greater Clinical Awareness: Healthcare providers are now more aware of CAD as a stroke cause, particularly in younger patients who do not exhibit traditional risk factors.
• Increased Incidence of Related Risk Factors: Certain lifestyle and environmental factors that contribute to arterial wall vulnerability, like connective tissue disorders and trauma, may be more prevalent or better recognized today.
• Changes in Physical Activity and Trauma Exposure: Minor neck injuries from activities such as chiropractic manipulations, sports, or even sudden neck movements have been linked to CAD, potentially contributing to higher incidence rates.

Who Is Most at Risk?

Unlike many other stroke causes that predominantly affect older adults, cervical artery dissection often affects younger individuals, typically between the ages of 30 and 50. It is one of the leading causes of ischemic stroke in this age group.

Additional risk factors include:

• Connective Tissue Disorders: Conditions such as Ehlers-Danlos syndrome or Marfan syndrome can weaken arterial walls.
• Recent Neck Trauma: Even minor trauma — from sports injuries, sudden head movements, or cervical manipulations — can precipitate CAD.
• Infections: Recent upper respiratory infections have been associated with increased risk, possibly due to inflammation affecting arterial walls.
• Genetic Predispositions: Some individuals may have an inherited susceptibility to arterial dissections.

Recognizing the Signs and Symptoms

Early recognition of CAD is crucial to preventing severe stroke outcomes. Symptoms often precede a stroke and may include:

• Sudden, severe neck or head pain localized around the affected artery
• Horner’s syndrome: drooping eyelid, constricted pupil, and decreased sweating on one side of the face
• Neurological deficits: such as weakness on one side of the body, difficulty speaking, vision disturbances, or dizziness
• Tinnitus or hearing changes can occasionally occur

If these symptoms arise, particularly after recent neck trauma or in younger patients without typical stroke risk factors, urgent medical evaluation is necessary.

Diagnosis and Treatment

Diagnosing cervical artery dissection relies heavily on imaging studies. Magnetic resonance imaging (MRI) combined with MRA is considered the gold standard for visualizing the dissection and any resultant ischemic injury. CTA and Doppler ultrasound can also be valuable tools.

Treatment aims to prevent stroke or recurrent stroke events. The main strategies include:

• Antithrombotic Therapy: Anticoagulants or antiplatelet agents are used to reduce clot formation and prevent embolism.
• Blood Pressure Management: Avoiding hypertension helps minimize arterial stress.
• Monitoring and Follow-Up: Regular imaging to assess healing of the arterial wall.
• Surgical or Endovascular Intervention: In rare cases with persistent or worsening symptoms, procedures to repair or bypass the dissection may be necessary.

The prognosis for patients with CAD is generally favorable if diagnosed and treated promptly, but delays can lead to severe neurological deficits or death.

Prevention and Public Health Implications

Given the dramatic rise in CAD-related strokes, public health initiatives should emphasize:

• Education: Raising awareness among healthcare providers and the public about the signs and risk factors of cervical artery dissection.
• Safe Practices: Encouraging caution around activities that could cause neck trauma, including certain sports and manual therapies.
• Early Screening: For individuals with connective tissue disorders or family history of arterial dissections.

Further research is also needed to explore the underlying causes of the increase and to develop targeted prevention strategies.

Conclusion

The 400% increase in stroke cases linked to cervical artery dissection since 2005 marks a significant shift in the epidemiology of stroke. Although still less common than other causes, CAD represents an important and potentially preventable source of stroke, especially in younger populations. Enhanced awareness, timely diagnosis, and appropriate management can improve outcomes and reduce the growing impact of this condition.

As medical technology advances and clinical knowledge expands, integrating this information into practice is essential for comprehensive stroke prevention and care.