NEW YORK, July 6: While most strokes are commonly linked to clots from the heart or fatty deposits in the carotid arteries, a new study highlights a lesser-known but rapidly increasing cause — cervical artery dissection. According to researchers, hospitalizations related to this type of stroke have surged by 400% between 2005 and 2019.

Dr. Shadi Yaghi, a vascular neurologist at Brown University, led a team that analyzed over 125,000 patient records to better understand this alarming trend.

Cervical artery dissection occurs when the inner lining of an artery in the neck tears, allowing blood to enter the layers of the artery wall. This can create a flap that slows blood flow or causes a clot, potentially leading to an ischemic stroke.

This condition is responsible for up to 25% of strokes in adults under 50, making it a significant risk for younger individuals. Often triggered by physical trauma such as car accidents, sports injuries, or even minor movements like reaching into a car’s backseat, these dissections can occur with little warning.

Advancements in ultrasound and MRI technology have improved detection of these injuries, revealing subtle signs that older equipment may have missed. This improved imaging is partly responsible for the increase in reported cases.

Recognizing the symptoms

Key warning signs include a sudden one-sided headache or neck pain, sometimes accompanied by a drooping eyelid. Some patients report hearing a pulsing sound in one ear, signaling turbulent blood flow. Physicians also check for Horner’s syndrome—a combination of a drooping eyelid and constricted pupil.

Emergency rooms increasingly rely on computed tomography angiography, a scan that uses dye to quickly map blood flow, now considered a primary diagnostic tool in young stroke cases.

The incidence of cervical artery dissection climbed from 11 to 46 cases per million over 15 years—an average annual increase of 10%. Hispanic and Black patients saw the steepest increases, nearly double those observed among white patients, suggesting disparities in trauma exposure and access to care.

Lower costs and improved access to scanning technology have enabled smaller hospitals to conduct vascular imaging, leading to more diagnoses.

“The impact of non-fatal strokes includes long-term disability and reduced quality of life,” said Dr. Yaghi, emphasizing the importance of early detection.

Interestingly, the largest increases were seen in people over 65, indicating that both age-related vascular changes and broader use of imaging may be uncovering previously undiagnosed cases.

Risk factors and prevention

Sports injuries, such as wrestling throws, surfing wipeouts, and extreme neck movements in yoga, have all been linked to dissections. A notable case involved a 34-year-old woman who suffered a fatal stroke after chiropractic neck manipulation.

Those with connective tissue disorders like Ehlers-Danlos syndrome, as well as individuals with high blood pressure or migraines with aura, are at higher risk. Vertebral artery tears are particularly concerning, nearly doubling stroke risk within 90 days even in cases that initially appear mild.

Treatment and gaps in care

Standard treatment involves antiplatelet therapy, such as aspirin, for 3 to 6 months. Anticoagulants are reserved for more severe cases or those affecting arteries near the brainstem. Follow-up imaging is typically performed within a week to ensure proper blood flow.

The American Heart Association supports the use of intravenous clot-busting drugs within the standard treatment window. Endovascular stenting is used in cases where symptoms recur despite medication, with success rates exceeding 90%.

Telehealth services have improved access to follow-up care in rural areas, potentially addressing racial disparities in stroke outcomes.

Steps to reduce risk

Simple preventive measures include wearing a seatbelt, adjusting headrests to eye level, and avoiding twisting the neck while lifting heavy items. Strength training should resume gradually after proper healing, using light weights and steady breathing.

Persistent one-sided headaches or neck pain after minor injuries should prompt medical evaluation, especially if accompanied by vision changes or slurred speech.

Ongoing research is exploring the use of direct oral anticoagulants, ultrasound markers to detect weak arteries early, and genetic studies to identify risk factors in connective tissue biology.