Skip to main content Accessibility help
  • Print publication year: 2012
  • Online publication date: August 2012

Chapter 51 - Intracranial arterial dissections

from Section 2 - Vascular topographic syndromes


A small number of syndromes that initially were correlated, more or less convincingly, with relevant lacunes observed at subsequent autopsy have come to be regarded as the classical lacunar syndromes (LACS), pure motor stroke (PMS), pure sensory stroke (PSS), homolateral ataxia and crural paresis (HACP), dysarthria-clumsy hand syndrome (DCHS), ataxic hemiparesis (AH), and sensorimotor stroke (SMS). The original cases of HACP were described as having weakness of the lower limb, particularly the ankle and toes, a Babinski sign, and striking dysmetria of the arm and leg on the same side. The classical LACS are clinical paradigms that should be fine-tuned by clinicians. They have been shown to be simple and reasonably valid markers for a numerically significant and pathophysiologically distinct subgroup of patients with cerebral infarction. Clinical and research utility of the classical LACS will have to be kept under review in the era of hyperacute stroke assessment and treatment.
Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Stroke Syndromes, 3ed
  • Online ISBN: 9781139093286
  • Book DOI:
Please enter your name
Please enter a valid email address
Who would you like to send this to *


1. ChavesC, EstolC, EsnaolaMM, et al. Spontaneous intracranial internal carotid artery dissection. Arch Neurol 2002; 59: 977–981.
2. FischerCM, OjemannG, RobersonGH.Spontaneous dissection of cervico-cerebral arteries. Can J Neurol Sci 1978; 5: 9–19.
3. CaplanLR, TettenbornB.Vertebrobasilar occlusive disease: review of selected aspects. I: Spontaneous dissection of extracranial posterior circulation arteries. Cerebrovasc Dis 1992; 2: 256–265.
4. MetsoTM, MetsoAJ, HeleniusJ, et al. Prognosis and safety of anticoagulation in intracranial artery dissections in adults. Stroke 2007; 38: 1837–1842.
5. CaplanLR, BaquisG, PessinMS, et al. Dissection of the intracranial vertebral artery. Neurology 1998; 38: 868–879.
6. BergerMS, WilsonCB.Intracranial dissecting aneurysms of the posterior circulation. J Neurosurg 1984; 61: 882–894.
7. PozzatiE, AndreoliA, LimoniP, CasmiroM.Dissecting aneurysms of the vertebrobasilar system: study of 16 cases. Surg Neurol 1994; 41: 119–124.
8. OhkumaH, SuzukiS, KikkawaT, et al. Neuroradiologic and clinical features of arterial dissection of the anterior cerebral artery. Am J Neuroradiol 2003; 24: 691–699.
9. CaplanLR, EstolCJ, MassaroAR.Dissection of the posterior cerebral arteries. Arch Neurol 2005; 62: 1138–1143.
10. SharifAA, RemleyKB, ClarkHB.Middle cerebral artery dissection: a clinicopathologic study. Neurology 1995; 45: 1929–1931.
11. AdamsC, TrevenenC.Middle cerebral artery dissection. Neuropediatrics 1996; 27: 331–332.
12. Le TuPT, ZuberM, MederJF, MasJL.Dissection isolee de l´artere cerebrale posterieure. Rev Neurol (Paris) 1996; 152: 542–547.
13. SasakiO, KoizumiT, ItoY, et al. Dissecting aneurysm of the posterior cerebral artery treated with proximal ligation. Surg Neurol 1992; 37: 394–401.
14. BerkovicSF, SpokesRL, AndersonRM, BladinPF.Basilar artery dissection. J Neurol Neurosurg Psychiatry 1983; 46: 126–129.
15. ArnoldM, StapfC, BaumgartnerRW, et al. Triple and quadruple spontaneous cervical artery dissection: presenting characteristics and long-term outcome. J Neurol Neurosurg Psychiatry 2009; 80: 171–174.
16. LucasC, MoulinT, DeplanqueD, TatuL, ChavotD.Stroke patterns of internal carotid artery dissection in 40 patients. Stroke 1998; 29: 2646–2648.
17. KochS, AmirM, RabinsteinAA, et al. Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection. Arch Neurol 2005; 62: 1228–1231.
18. PrabhakaranS, KrakauerJW.Multiple reversible episodes of subcortical ischemia following postcoital middle cerebral artery dissection. Arch Neurol 2006; 63: 891–893.
19. InoueT, NishimuraS, HayashiN, et al. Postpartum dissecting aneurysm of the posterior cerebral artery. J Clin Neurosci 2007; 14: 576–581.
20. PessinMS, AdelmanLS, BarbasNR.Spontaneous intracranial carotid artery dissection. Stroke 1989; 20: 1100–1113.
21. BahrM, PostlerE, MeyermannR.Fatal stroke in a patient with carotid and middle cerebral artery dissection associated with cystic medial necrosis. J Neurol 1996; 243: 722–723.
22. OhkiM, NakajimaM, SatoK, et al. A case of dissecting aneurysm associated with mixed connective tissue disease. No To Shinkei 1994; 46: 855–858.
23. SzatmaryZ, BoukobzaM, VahediK, et al. Orgasmic headache and middle cerebral artery dissection. J Neurol Neurosurg Psychiatry 2006; 77: 693–694.
24. SinclairW.Dissecting aneurysm of the middle cerebral artery associated with migraine syndrome. Am J Pathol 1953; 29: 1083.
25. FarrellMA, GilbertJJ, KaufmannJC.Fatal intracranial arterial dissection: clinical pathological correlation. J NeurolNeurosurg Psychiatry 1985; 48: 111–121.
26. ZweiflerR, SilverboardG.Arterial dissections. In: MohrJP, ChoiDW, GrottaJC, WeirB, WolffPA, eds. Stroke: Pathophysiology, Diagnosis andMmanagement. Philadelphia, PA: Churchill Livingstone, 2004; 561.
27. HosoyaT, AdachiM, YamaguchiK, et al. Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 1999; 30: 1083–1090.
28. FriedmanAH, DrakeCG.Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 1984; 60: 325–334.
29. YonasH, AgamanolisD, TakaokaY, WhiteRJ.Dissecting intracranial aneurysms. Surg Neurol 1977; 8: 407–415.
30. AdamsHP, AschenbrenerCA, KassellNF, AnsbacherL, CornellSH.Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 1982; 39: 773–776.
31. FisherCM.Headache in cerebrovascular disease. In: VinkenPJ, BruynGW, eds. Handbook of Clinical Neurology. Amsterdam: North-Holland Publishing Company, 1968; 124–156.
32. NassR, HaysA, ChutorianA.Intracranial dissecting aneurysms in childhood. Stroke 1982; 13: 204–207.
33. BiousseV, D'Anglejan-ChatillonJ, MassiouH, BousserMG.Time course of symptoms in extracranial carotid artery dissections. A series of 80 patients. Stroke 1995; 26: 235–239.
34. ArnoldM, BousserMG, FahrniG, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006; 37: 2499–2503.
35. KennedyG, RuaneP, RenowdenS, et al. Spontaneous anterior intracranial artery dissection: an important cause of stroke in young people. Adv Clin Neurosci Rehabil 2008; 8: 30–31.
36. DuncanA, RumbaughC, CaplanL.Cerebral embolic disease: a complication of carotid aneurysms. Radiology 1979; 133: 379–384.
37. MatscheJ.Fatal ischemic stroke due to dissecting aneurysm of the intracranial arteries presenting as sudden unexpected death in childhood. Am J Forensic Med Pathol 2010; 31: 364–369.
38. ChangV, RewcastleNB, Harwood-NashDCF, NormanMG.Bilateral dissecting aneurysms of the intracranial carotid arteries in an 8 year old boy. Neurology 1975; 25: 573–579.
39. HochbergFH, BeanC, FisherCM, RobertsonGH.Stroke in a 15 year old girl secondary to terminal carotid dissection. Neurology 1975; 25: 725–729.
40. OhkumaH, SuzukiS, OganeK, for the Study Group of the Association of Cerebrovascular Disease in Tohoku, Japan. Dissecting aneurysms of intracranial carotid circulation. Stroke 2002; 33: 941–947.
41. HsuKC, KaoHW, ChenSJ.Backward somersault as a cause of childhood stroke: a case report of isolated middle cerebral artery dissection in an adolescent boy. Am J Emerg Med 2008; 26: 519, e3–5.
42. AbeA, NishiyamaY, KamiyamaH, et al. Symptomatic middle cerebral artery dissection in a young tennis player. J Nihon Med Sch 2009; 76: 209–211.
43. YakushijiY, HaraguchiY, TakaseY, et al. A hyperdense artery sign and middle cerebral artery dissection. Intern Med 2006; 45: 1319–1322.
44. VernyC, MarcG, PascoA, DubasF.Middle cerebral artery dissection gives rise to giant serpentine aneurysm. Cerebrovasc Dis 2008; 25: 283–285.
45. KondohR, UtsugisawaK, ObaraD, et al. Striatocapsular infarction caused by middle cerebral artery dissection. Eur Neurol 2004; 51: 120–121.
46. SasakiO, KoikeT, TakeuchiS, TanakaR.Serial angiography in a spontaneous dissecting anterior cerebral artery aneurysm. Surg Neurol 1991; 36: 49–53.
47. GuridiJ, GallegoJ, MonzonF, AguileraF.Intracerebral hemorrhage caused by intramural dissection of the anterior cerebral artery. Stroke 1993; 24: 1400–1402.
48. KoyamaS, KotaniA, SasakiJ.Spontaneous dissecting aneurysm of the anterior cerebral artery: report of two cases. Surg Neurol 1996; 46: 55–61.
49. MatsumotoS, TakadaT, KazuiS, et al. Rotational angiographic demonstration of dissection of the anterior cerebral artery. Cerebrovasc Dis 2005; 20: 55–58.
50. SatoS, ToyodaK, MatsuokaH, et al. Isolated anterior cerebral artery territory infarction: dissection as an etiological mechanism. Cerebrovasc Dis 2010; 29: 170–177.
51. ShimoyamaT, KimuraK, IguchiY, et al. Spontaneous intra-cranial arterial dissection frequently causes anterior cerebral artery dissection. J Neurol Sci 2011; 304: 40–43.
52. ThinesL, ZairiF, TaschnerC, et al. Subarachnoid hemorrhage from spontaneous dissection of the anterior cerebral artery. Cerebrovasc Dis 2006; 22: 452–456.
53. MoriK, YamamotoT, MaedaM.Dissecting aneurysm confined to the anterior cerebral artery. Br J Neurosurg 2002; 16: 158–164.
54. ShermanP, OkaM, AldrichE, JordanL, GailloudP.Isolated posterior cerebral artery dissection. Report of three cases. Am J Neuroradiol 2006; 27: 648–652.
55. DuncanIC.Clinically occult chronic dissecting aneurysm of the superior cerebellar artery in a child. Pediatr Radiol 2005; 35: 1118–1120.
56. SedatJ, ChauY, MahagneMH, et al. Dissection of the posteroinferior cerebellar artery: clinical characteristics and long-term follow-up in five cases. Cerebrovasc Dis 2007; 24: 183–190.
57. von Stuckrad-BarreS, ZiemannU, SitzerM, WeidauerS.Ischemic-type posterior inferior cerebellar artery dissection – a case report. Eur J Neurol 2007; 14: e36.
58. TakumiI, MizunariT, MishinaM, et al. Dissecting posterior inferior cerebellar artery aneurysm presenting with subarachnoid hemorrhage right after anticoagulant and antiplatelet therapy against ischemic event. Surg Neurol 2007; 68: 103–107.
59. DemirgilB, GünaldiO, TugcuB, et al. Multiple aneurysms of the distal posterior inferior cerebellar artery: two case reports. Minim Invasive Neurosurg 2008; 51: 249–252.
60. SaitoA, EzuraM, TakahashiA, YoshimotoT.An arterial dissection of the distal anterior inferior cerebellar artery treated by endovascular therapy. No Shinkei Geka 2000; 28: 269–274.
61. KimBM, KimSH, KimDI, et al. Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 2011; 76: 1735–1741.
62. HuangYC, ChenYF, WangYH, et al. Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol 2009; 72: S20–S27.
63. BaumgartnerRW, ArnoldM, BaumgartnerI, et al. Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings. Neurology 2001; 57: 827–832.
64. KingAS, OsmanA, WillsonM, et al. Embolic signal detection at baseline in the cervical artery dissection in stroke study (CADISS). Int J Stroke 2009; 43: 1–45.
65. GuillonB, LevyC, BousserMG.Internal carotid artery dissection: an update. J Neurol Sci 1998; 153: 146–158.
66. NedeltchevK, BickelS, ArnoldM, et al. Recanalization of spontaneous carotid artery dissection. Stroke 2009; 40: 499–504.
67. GuillonB, BrunereauL, BiousseV, et al. Long-term follow-up of aneurysms developed during extracranial internal carotid artery dissection. Neurology 1999; 53: 117–122.
68. SturzeneggerM, MattleHP, RivoirA, RihsF, SchmidC.Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke 1993; 24: 1910–1921.
69. NagasawaH, TomiiY, YokotaC, et al. Acute morphological change in an extracranial carotid artery dissection on transoral carotid ultrasonography. Circulation 2008; 118: 1064–1065.
70. de BrayJM, MarcG, PautotV, et al. Fibromuscular dysplasia may herald symptomatic recurrence of cervical artery dissection. Cerebrovasc Dis 2007; 23: 448–452.
71. PozzatiE, PadovaniR, FabriziA, SabatiniL, GaistG.Benign arterial dissections of the posterior circulation. J Neurosurg 1991; 75: 69–72.
72. BassettiC, BogousslavskyJ, Eskenasy-CottierAC.Spontaneous intracranial dissection in the anterior circulation. Cerebrovasc Dis 1994; 4: 170–174.
73. KitanakaC, SasakiT, EguchiT, et al. Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 1994; 34: 620–627.
74. FullertonHJ, JohnsonSC, SmithWS.Arterial dissection and stroke in children. Neurology 2001; 57: 1155–1160.
75. PelkonenO, TikkakoskiT, LeinonenS, PyhtinenJ, SotaniemiK.Intracranial arterial dissection. Neuroradiology 1998; 40: 442–447.