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From the Departments of Neurology (V.H.L., R.D.B., B.M.), and Biostatistics (J.N.M.), Mayo Clinic College of Medicine, Rochester, MN. Dr. Lee is currently with the Department of Neurology, Rush University Medical Center, Chicago, IL.
Address correspondence and reprint requests to Dr. Bahram Mokri, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905; e-mail: bmokri{at}mayo.edu
Background: Incidence rates for internal carotid artery dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available.
Objective: To determine the incidence rate of cervical artery dissection (CAD) in a defined population.
Methods: With IRB approval, we used the medical record linkage system of the Rochester Epidemiology Project to identify all patients diagnosed with spontaneous ICAD and VAD for the period of 1987–2003 in Olmsted County, MN.
Results: Of 48 patients with CAD, there were 32 patients with ICAD and 18 patients with VAD. In Olmsted County, the average annual incidence rate for ICAD was 1.72 per 100,000 population (95% CI, 1.13 to 2.32) and for VAD 0.97 per 100,000 population (95% CI, 0.52 to 1.4). The average annual incidence rate for CAD was 2.6 per 100,000 population (95% CI, 1.86 to 3.33). The most frequently encountered symptoms in CAD were head or neck pain (80%), cerebral ischemia (TIA or infarct) (56%), and Horner syndrome (25%). Good outcome (defined as modified Rankin score of 0 to 2) was seen in 92% of patients. No recurrence of dissection was observed during a mean 7.8 years of follow-up.
Conclusions: Internal carotid artery dissection was detected approximately twice as frequently as vertebral artery dissection in the overall study, but in the latter half of the study period, vertebral artery and internal carotid artery dissection incidence rates were equivalent. The majority of cervical artery dissection patients in the community have excellent outcome, and contrary to many tertiary referral series, re-dissection is rare.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the November 28 issue to find the title link for this article.
Disclosure: The authors report no conflict of interest.
Received April 3, 2006. Accepted in final form August 4, 2006.
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