Ultraschall Med 2023; 44(02): 126-150
DOI: 10.1055/a-2004-4986
Continuing Medical Education

Ultrasound Criteria for Diagnosing Spontaneous Cervical Artery Dissections

Article in several languages: English | deutsch
Neurology, Praxis Neuro-Ultraschall, Hamburg, Germany
› Author Affiliations


Spontaneous dissection of brain-supplying cervical arteries, which also includes findings after minor injuries, is one of the main causes of ischaemic strokes in young adults. Strokes due to dissection are usually due to arterio-arterial embolism. They are rarely the first symptom of dissection because an intraluminal thrombus must first develop. Therefore, early diagnosis of dissection can contribute to stroke prevention – through immediate therapy with anticoagulants or antiplatelet drugs. This article describes the diagnostic criteria and typical findings of spontaneous dissection, in which no dissecting membrane is to be expected as in aortic dissection. Traumatic dissections following blunt or penetrating injuries also present with different findings. Examiners should be aware of possible differential diagnoses whose ultrasound image may mimic a dissection. A frequently occurring but avoidable cause of misdiagnosis is idiopathic carotidynia. Ultrasound also enables differentiation between dissection and vasculitis or carotid web and detection of normal variants such as fenestration of the vertebral artery. Further possibilities for misdiagnosis may arise in the presence of a variant of the ascending pharyngeal artery or in extracranial vasospasm. The different imaging techniques for the detection of a dissection are complementary, as false-negative findings occur with all techniques; no method serves as the gold standard. In any case, ultrasound can make an important contribution to the detection of a dissection, and it is worth knowing the diagnostic criteria.

Publication History

Article published online:
06 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Micheli S, Paciaroni M, Corea F. et al. Cervical artery dissection: emerging risk factors. Open Neurol J 2010; 4: 50-55
  • 2 Biller J, Sacco RL, Albuquerque FC. et al. Cervical arterial dissections and association with cervical manipulative therapy: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2014; 45: 3155-3174
  • 3 Arning C, Hanke-Arning K, Eckert B. Clinical features of dissection of the cervical brain-supplying arteries. Dtsch Arztebl Int 2022; 119: 581-587
  • 4 Arning C, Hanke-Arning K. Vertebral artery dissection after-and also before-chirotherapy. J Neurol 2022; 269: 3353-3354
  • 5 Ringelstein E, Dittrich R, Sitzer M. et al. S1-Leitlinie Spontane Dissektionen der extra- und intrakraniellen hirnversorgenden Arterien. In: Deutsche Gesellschaft für Neurologie. Leitlinien für Diagnostik und Therapie in der Neurologie. 2016. www.dgn.org/leitlinien
  • 6 Caplan LR. Dissections of brain-supplying arteries. Nat Clin Pract Neurol 2008; 4: 34-42
  • 7 Arning C, Oelze A, Lachenmayer L. Eine seltene Schlaganfallursache: die Aortendissektion. Akt Neurol 1995; 22: 189-192
  • 8 Debette S. Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?. Curr Opin Neurol 2014; 27: 20-28
  • 9 Arning C, Rieper J, Kazarians H. Nicht arteriosklerotische Erkrankungen der Halsarterien. Ultraschall in Med 2008; 29: 576-593
  • 10 Béjot Y, Aboa-Eboulé C, Debette S. et al. Characteristics and outcomes of patients with multiple cervical artery dissection. Stroke 2014; 45: 37-41
  • 11 Nebelsieck J, Sengelhoff C, Nassenstein I. et al. Sensitivity of neurovascular ultrasound for the detection of spontaneous cervical artery dissection. J Clin Neurosci 2009; 16: 79-82
  • 12 Benninger DH, Baumgartner RW. Ultrasound diagnosis of cervical artery dissection. Front Neurol Neurosci 2006; 21: 70-84
  • 13 Arning C. Die Karotidynie im Ultraschallbild: Mythos, Syndrom oder Krankheitsbild?. Nervenarzt 2004; 75: 1200-1203
  • 14 Arning C. Ultrasonography of carotidynia. AJNR Am J Neuroradiol 2005; 26: 201-202
  • 15 Arning C. Carotid Web Mimicking Dissection. Stroke 2022; 53: e192
  • 16 Arning C. Fensterung der A. vertebralis – Verwechslungsmöglichkeit mit einer A. vertebralis-Dissektion. Akt Neurol 2004; 31: 132-134
  • 17 Cavalcanti DD, Reis CVC, Hanel R. et al. The ascending pharyngeal artery and its relevance for neurosurgical and endovascular procedures. Neurosurgery 2009; 65 (01) 114-120
  • 18 Pohlmann C, Urban PP, Brüning R. et al. Potential errors in vascular patients due to anatomical variants of the ascending pharyngeal artery. Nervenarzt 2018; 89: 460-462
  • 19 Arning C, Schrattenholzer A, Lachenmayer L. Cervical carotid artery vasospasms causing cerebral ischemia: detection by immediate vascular ultrasonographic investigation. Stroke 1998; 29: 1063-1066
  • 20 Fujii Y, Hanaoka Y, Ogiwara T. et al. Pediatric Case of Life-Threatening Stroke Caused by Reversible Cerebral Vasoconstriction Syndrome with Spontaneous Cervical Internal Carotid Artery Vasospasm: A Case Report. J Stroke Cerebrovasc Dis 2021; 30: 106036