Cervical artery dissections involve the carotid or vertebral arteries. An intimal tear creates a pseudolumen with intramural hematoma, which can later lead to vessel occlusion, thrombus formation, embolus, pseudoaneurysm, or rupture.
Cervical artery dissections from blunt trauma are caused by direct blow to the neck, hyperextension or contralateral rotation, intraoral trauma, or skull-base fractures. However, they can also occur spontaneously or with minor trauma. On average, symptoms occur 2 to 3 days after the traumatic event.
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Upon completion of this article, you should be able to:
List the risk factors for carotid and vertebral artery dissections.
Describe clues in the history and physical examination that can be indicative of a dissection.
Perform appropriate emergency department workup for carotid and vertebral artery dissections.
Initiate the appropriate interventions to prevent stroke and for the treatment of acute ischemic strokes due to dissections.
Physician CME Information
Date of Original Release: July 1, 2016. Date of most recent review: June 10, 2016. Termination date: July 1, 2019.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ACEP Accreditation: Emergency Medicine Practice is approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
AAFP Accreditation: This Medical Journal activity, Emergency Medicine Practice, has been reviewed and is acceptable for up to 48 Prescribed credits by the American Academy of Family Physicians per year. AAFP accreditation begins July 1, 2016. Term of approval is for one year from this date. Each issue is approved for 4 Prescribed credits. Credit may be claimed for one year from the date of each issue. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AOA Accreditation: Emergency Medicine Practice is eligible for up to 48 American Osteopathic Association Category 2-A or 2-B credit hours per year.
Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits and 4 Stroke CME credits, subject to your state and institutional approval.
Needs Assessment: The need for this educational activity was determined by a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation of prior activities for emergency physicians.
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Goals: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the strongest clinical evidence; (2) cost-effectively diagnose and treat the most critical presentations; and (3) describe the most common medicolegal pitfalls for each topic covered.
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