Association of Cervical Artery Dissection With Recent Infection

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Abstract
CERVICAL ARTERY dissection (CAD) is increasingly recognized as an important cause of stroke and transient ischemic attack in young and middle-aged patients. In about 15% to 20% of younger patients, CAD may be the cause of cerebral ischemia.1,2 However, the pathogenesis of nontraumatic CAD is unclear. An underlying arteriopathy has often been presumed. In electron microscopic studies of skin biopsy specimens, we recently found evidence of abnormally structured collagen fibrils and/or elastin in about two thirds of patients with CAD.3 The aberrations consisted of collagen bundles with flowerlike cross sections and with numerous composite fibrils of variable, sometimes enlarged (in more severe cases) diameter. Elastic fibers showed minicalcifications and pronounced fragmentation in the most severe cases. Genetically determined alterations of the extracellular matrix may be an important predisposing factor for CAD. However, such preexisting abnormalities do not explain all clinical features of this disease. Cervical artery dissection is characterized by a low rate of recurrence,4 and often there is simultaneous dissection of multiple cervical and sometimes also of renal arteries.5,6 Also, familiar occurrence is low. These observations suggest that short-lived trigger mechanisms may play an important role in the pathogenesis of CAD.