Clinical characteristics of symptomatic vertebral artery dissection a systematic review

Rebecca F. Gottesman, Priti Sharma, Karen A. Robinson, Martinson Arnan, Megan Tsui, Karim Ladha, David E. Newman-Toker

Research output: Contribution to journalReview articlepeer-review

62 Scopus citations


Background: Vertebral artery dissection (VAD) is an important cause of stroke in the young. It can present nonspecifically and may be misdiagnosed with adverse consequences. We assessed the frequency of head/neck pain, other neurological symptoms, and cerebrovascular events in symptomatic VAD. Methods: We conducted a systematic review of observational studies, searching electronic databases (MEDLINE, EMBASE) for Englishlanguage manuscripts with >5 subjects with clinical or radiologic features of VAD. Two independent reviewers selected studies for inclusion; a third adjudicated differences. Studies were assessed for methodological quality, and clinical data were abstracted. Pooled proportions were calculated. Results: Of 3996 citations, we screened 511 manuscripts and selected 75 studies describing 1972 VAD patients. The most common symptoms were dizziness/vertigo (58%), headache (51%), and neck pain (46%). Stroke was common (63%), especially with extracranial dissections (66% vs. 32%, P < 0.0001), whereas transient ischemic attack (14%) and subarachnoid hemorrhage (10%) were uncommon. Subarachnoid hemorrhage was seen only with intracranial dissections (57% vs. 0%, P = 0.003). Fewer than half of the patients had obvious trauma, and only 7.9% had a known connective tissue disease. Outcome was good (modified Rankin scale 0 to 1) in 67% and poor (modified Rankin scale 5 to 6) in 10% of patients. Conclusions: VAD is associated with nonspecific symptoms such as dizziness, vertigo, headache, or neck pain. Ischemic stroke is the most common reported cerebrovascular complication. VAD should be considered in the diagnostic assessment of patients presenting with dizziness or craniocervical pain, even in the absence of other risk factors. Future studies should compare clinical findings as predictors in well-defined, undifferentiated populations of clinical VAD suspects.

Original languageEnglish (US)
Pages (from-to)245-254
Number of pages10
Issue number5
StatePublished - Sep 2012


  • Dizziness
  • Meta-analysis
  • Vertebral artery dissection

ASJC Scopus subject areas

  • Clinical Neurology


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