Cervical Arterial Dissections

[@alicedepoil3101]

Clarity, details, illustrations, explanations... Perfect. Thank you

[@FaisalRasheed33]

Wonderfully explained. Thank you!

[@salvusky]

Young spanish neurologist here, this is just AWESOME, congrats and thanks so much!!! this is HBO neurology material

[@Chiboza]

Hey there! VAD survivor here. I see plenty of people asking if they have dissections or not both here and on our VAD group... To answer it simply, no one can answer this question apart your radiologist. There could be a whole myriad of other conditions that require medical investigation. If you will be referred to get imaging - other issues that could affect your neck will be checked too as mentioned by the author of this video - dissections are quite rare, but cervical herniated discs are not (it's just an example!). Please do not try to self-medicate as if you have an active intracranial dissection, you can easily cause a hemorrhagic event. Also, I had 0 symptoms during my dissection that spanned from V4 to V3. No pain, no discomfort. Until two days later after the trauma, I had two very symptomatic brainstem strokes... And I've met loads of people who had no symptoms as well and their dissection findings were incidental. Hope that makes any sense. Please don't waste your time waiting for someone to guess if you have this or not, if in doubt - check it out.

[@yifengling547]

Thank you for the EXCELLENT video. The BEST I have ever seen.

[@Raminaw1234]

i cannot find the best words to thank you for this excellent presentation. Thank you for your precious time and your kindness Dr Rybinnik 😍😍😍😍😍😍😍😍

[@DanielMandel1991]

excellent video! please post more. Love the special effects

[@jacks3134]

Brilliantly presented and so good at summarizing a confusing area for so many in a very digestible way

[@MrSipi1986]

Really useful video. Helping me to prepare for my final exams of my Osteopathy degree. Thank you!

[@ammaraquazi]

You made neurology so interesting! Thank you

[@marcinbok9166]

Amazing thought-through lecture. Thank you.

[@joyceszoladi3704]

Thank you. Very well explained.

[@stevejodoin9937]

Great presentation. This makes learning quite fun.

[@the-neurosurgeon]

Brilliant presentation as always . Please make a video on higher mental functions .

[@melissagutierrez7357]

what`s this beautifull content!! thank you so much

[@gabbiet9138]

I absolutely love all of your videos. I'm currently working in a neurology office. It's definitely interesting.. and very complex.

[@theneurophile]

Thank you! These take forever to make, but I am trying to make them as fast as I can.

[@themostpopularsite]

8:21 symptomatic elongated styloid processes colloquially are also known as "Eagle's syndrome" (Classic/Vascular version), which is relatively rare and many doctors are not even aware of the condition... I'm really happy to see it being more and more recognised as the potential cause of lesions/dissections/impingements of blood vessels. Surgical resection/shortening of the styloid processes is an option too if they are in close proximity/contact with the ICA or even CCA in some cases. In some cases, elongated greater horns of the hyoid bone may cause dissections too

[@Chiboza]

Laba diena Vidmantai, gal zinote kaip Erelio sindromas nustatomas? Aš deja nežinau dėl ko man buvo disekcija, ir norėčiau ištirti šitą dalyką. Turėjau apie 20 CT/CTA/MRI/MRA, bet specialistai tiesiog gūsčioja pečiais, bet kaip suprantu - į šį sindromą net nežiūri.

[@jamesgilmour8794]

Thanks for your video,I had a spontaneous vertebral artery dissection and multiple strokes I wish more people new these symptoms

[@theneurophile]

I'm sorry to hear about your misfortune. One of the reasons I created this channel is to teach and inspire young physicians.

[@samanthawhite9026]

What were your symptoms

[@saidineshtamilselvan9511]

@@theneurophile I suspect cervical dissection,I heard cracking sound in the back of my neck,,I am not able to move my neck properly,I have a feeling of some hard substance struck on my base of my head.Nt able to walk properly what should I do please give some suggestions

[@theneurophile]

@@saidineshtamilselvan9511 I suggest you start by vising your physician. There are many disorders that can affect the neck, and you need a trained professional to evaluate you.

[@jamesgilmour8794]

My symptoms where headache, vision problems and fatigue.

[@Alejandraisabeljimenez]

Excellent video. Thank you!!

[@niceyesplease]

Great content! Thank you!

[@zeljkacuk4498]

amazing lecture! thank you for doing these great videos!

[@olanil68]

52 yo male in Sweden. Left side Horners (didn´t know what that was) and a mild headache was my only signs 9 days ago. Diagnosed with internal carotid dissection. Everything that was done to me and that the doctors told me, matches the facts and conclusions in this video. Kind of comforting.

[@theneurophile]

I'm sorry to hear that you sufferred a dissection, but I am glad to hear that everything turned out well.

[@olanil68]

@White Cloud Thanks for asking, follow up CT after 3 months (a year ago) showed everything normal again.

[@olanil68]

@White Cloud None at all and I was even able to go back to my work as a helicopter pilot in april. May I ask why you wonder, did you have an own experience?

[@olanil68]

@White Cloud No problem :) Well I might have been to hard on my neck when stretching , but that I will never now for sure. Many dissections are "spontaneous" but I guess that means we don´t know what actually happened. Take care and enjoy life, 19 is a lovely age to be ;)

[@live12617]

​@@olanil68 hello , bro im having severe neck pain that radiates into muy shoulder and chest . I get popping, grinding sound in neck, head , ears and throat i did cervical spine mri and everything is normal . What test should i do to know its artery dissection . Also did u also experienced these symptoms. Bro please reply I'm 21. I'm suffering the pain from 3 months

[@AntonBerezhn]

The best. You are amazing 😻

[@f8-4-4n-fighter8]

Duuuuude!!! Love the videos

[@Mr_3raqi]

Thanks for the amazing lecture

[@alzahraa7068]

I wound bay for more episodes 😢

[@abhishekshrestha1585]

Brilliant

[@homashahnawaz31]

very nice.

[@vxp999]

Thank you very much for the amazing presention! I hope you make an up-dated video on the treatment option assuming there is a 2021 AHA new treatment guidlines

[@theneurophile]

The treatment for dissections hasn’t really changed. Per CADISS/CADISP, aspirin is still favored over anticoagulation.

[@vxp999]

Thank you! would you give aspirin alone or DAPT for 3-6 months in pts with Dissection?@@theneurophile

[@Rainyumz]

amazing

[@lauramarder2271]

Currently experiencing a bilateral dissection myself. Would love to be a case study..4 hospital visits completely missed it. ENT diagnosed outpatient with CT Angiogram. Thanks for the great info..gives me hope for healing.

[@theneurophile]

I'm sorry that you are experiencing a dissection. I'm glad that you got a diagnosis. Wishing you a speedy recovery.

[@drroussakis]

What's the treatment 24:09 recommendations for uncomplicated vertebral artery dissections? Aspirin or Anticoagulants?

[@theneurophile]

Aspirin.

[@willstrong3227]

very useful video. thank you

[@sakis908]

Excellent presentation congratulations. I am an obstetrician and Gynecologist and i have a question for my self. I have recently experienced a VAD that was unilateral (LVAD) and a small ishemic stroke on the left region of medulla during my night shift in the hospital. It has been 5 months since then. I am 48 years old and i have no appreciable neurological damage. My recently CTA (2 months ago) shows that the vessel is still obstructed on V3. seagment. If the vessel recanalized how soon can i return to my athletic activities (running or sit ups)?

[@theneurophile]

Thank you. Typically, 3 months after the dissection, if everything remains stable physical activity may be resumed.

[@candaniel]

In which video do you talk about the different diagnostic imaging methods (CTA with contrast & MRA with contrast) in closer detail again? You said there are more info in your "Intro to stroke doc" (6:26), but not sure what video that refers to I am thinking about getting checked for this since I am having a continual head ache and had to deal with a weird feeling in the brain and nausea (but no pain, no neurological defects, no other symptoms), which I started having yesterday immediately after doing some intense exercises with a vibrating rod (in the excercise there are a lot of abrupt back-and-forth movements in the cervical spine because it has to stabilize the vibrations). I am 22 btw, otherwise healthy, but have some problems with my back (several protrusions, a diagnosed spinal syndrome) I waited whether it got better but it stayed there, so I went to an emergency clinlic. I was checked (blood values, blood pressure, ecg) and everything was normal, but I rejected a CTA because it felt like it was getting slightly better and I was put off by the many warnings about the radiation in the hospital. I don't know if I am overly cautious with regards to these, but I am hesitant because of the radiation in the CT and contrast mediums like gadolinum in MRAs. If it's necessary to have an early diagnosis that could be very valuable, it might obviously be worth it, but I dunno if my symptoms are too few to really warrant that. It might just be tight muscles in my neck for all I know that cause these headaches. I'll also go to my doctor to speak about this with her and get her recommendations today.

[@theneurophile]

I am sorry that you are experiencing pain and difficulties. I just want to point out that it is a very bad idea to apply information from learning videos intended for medical trainees to diagnose or treat a person without a proper evaluation by a qualified physician. Vast majority of head and neck pain is NOT due to a dissection. However, if you are concerned, there is really no substitute to visiting a neurologist who can decide if and what testing is necessary. The differences between vascular imaging studies are discussed in the cerebrovascular anatomy video.

[@jenmaire5367]

Hi, what do you mean by dissections having a low risk of stroke? I thought the literature said around 70% risk of stroke with carotid artery dissection? I’m just trying to understand the “generally a benign disease” part.

[@theneurophile]

The absolute risk of stroke with dissection is generally around 1-2%. 98% of patients that dissect actually do not develop a stroke.

[@jenmaire5367]

@@theneurophile Thank you for your reply, do you have a paper where I could read about this?

[@heatheryoutube1506]

What causes FMD? ❤❤❤

[@theneurophile]

It's not known. It's a non-inflammatory vasculopathy where segments of vessels get fibrosed and narrow. It may be something that is congenital.

[@JoyShuai]

I was diagnosed "No acute ischemic injury. There are two areas of most conspicuous focal narrowing of the left common carotid artery, the narrowest spanning approximately 3 cm in length with an intramural hematoma best seen on the proton density sequence is consistent with focal dissection of the vessel with maximal luminal narrowing of approximately 60%. Proximally there is an intramural hematoma best seen on series 15, image 34." on 4-5-2023 at the ER. They discharged me and asked me to make an appointment with a neurologist within 2-3 days. I made 100 calls. The earliest appointment is in October. What should I do now? I used to play tennis 5 times a week. 2 hours a day. I am 53 years old. very fit.

[@theneurophile]

I am sorry to hear that you were diagnosed with a dissection. If there is no stroke, there is a very good chance that dissection will heal on its own without any dangerous consequences. Please keep looking for neurologists to get evaluated properly.

[@陳柏廷-u5p]

But.... 24:01 what is the treatment for the second case? since he had ataxia and both vertebral artery dissected and presented with ataxia, did he receive some surgery or just IV TPA ?

[@theneurophile]

I'm sorry I don't recall if he came in within the TPA window, but if he did, he would have received it. Endovascular stenting for dissections is very, very, very rare and only reserved for patients who have repeated strokes. Thrombectomy is more challenging with dissections but has to be performed in patients with proximal occlusions with disabling deficits (just like any other patient presenting with acute ischemic stroke).

[@ericasimpson8584]

Clarification needed…. In a vertebral artery dissection with stenosis of v1 v2 and v4 , is the procedure stent or thrombi lysis?

[@theneurophile]

Sure. Vertebral artery dissections at V1-V3 are usually treated with aspirin (no stenting) because vast majority of dissections heal on their own. Dissections at V4 (when vessel becomes intracranial) are either treated conservatively or with embolization (not stenting) if the vessel appears to be dangerously week and about to rupture. Thrombolysis can be considered when patients present with stroke symptoms in the setting of dissection of any carotid or vertebral segment as long as hemorrhage has been excluded and there are no concerns for high risk of vessel rupture (intracranial dissection).

[@jamesalles139]

SNOOP: +Vertigo.

[@mAriE6779]

Bonjour je me permet de vous poser la question en français: y a t il des precautions à prendre après cicatrisation d'une dissection de l'artère vertébrale ?

[@theneurophile]

Oui. Pendant les premiers mois, nous conseillons d’éviter les activités qui peuvent fatiguer le cou comme les sports de contact rapproché, le yoga, les montagnes russes et la manipulation chiropratique du cou. Comme toujours, veuillez suivre les conseils de votre propre médecin.

[@SebastianGaticaMoris]

I missed Darth Vader in your presentation :)

[@Johns367]

Can you have transient neck pain for months that becomes extremely painful and then goes away almost completely if this is the problem? Aspirin is the only thing that helps.

[@theneurophile]

I'm sorry that you are having difficulties. Unfortunately it is impossible to diagnose from a comment on an internet post. I recommend that you visit a physician for a formal evaluation.

[@Johns367]

@@theneurophilei believe I’ve had this for almost 3 months now. Joints popping when the neck pain flairs up. Only aspirin helps. Going to doctor tomorrow. Do you think i caused and necrosis or damage to bones or joints from lack of blood flow or if one side is blocked can bi lateral diffusion be sufficient? I read you can have this with no symptoms because you have two arteries. Have had slight blurred vision and extreme malaise. No joint paint other then in neck. Do you need treatment for this to heal on its own?

[@Johns367]

To heal*

[@Johns367]

How likely is brain damage if one artery is blocked?

[@Johns367]

And i have bad tinnitus

[@tricothon]

Hi ! Thank you for this extremely informative video. I am 46 yo and otherwise very healthy and I suffered a right carotid dissection in january. I was told by the neurologist of a 90% blockage and I had vision loss of the right eye and extreme fatigue. I am only on aspirin, now finished with Plavix. My vision came back but I struggle to know what activities I should do. I tryed a little bit of gentle cycling, a tiny bit of gardening (not the same day) but as soon as I put an effort I feel pressure in my neck where the arthery is. I also ended up very tired after go back to 8-9 hours of sleep and a more active day. I was told my blockage had reduced to about 50% mid-february so I was expecting to be healed by now. Is this part of the normal recovery process? I couldn’t find information on what activities I was allowed to do at the beginning of my convalescence. I guess I am at a point where I just should increase efforts gradually? Thank you for any guidance or opinion.

[@theneurophile]

I’m sorry to hear that. The symptoms that you describe are certainly common in people who develop dissections. In general we ask people to avoid straining the neck for at least 3-6 months with maneuvers like yoga (standing on the head), close contact sports, heavy lifting of over 50lbs above the neck, skiing, rollercoasters, etc. Normal activities should be ok, but I would defer to your neurologist who knows your specific case to let you know when it is safe to continue pushing yourself.

[@tricothon]

@@theneurophile Thank you so much for answering so quickly! I really appreciate it. It is reassuring to me that I haven’t done anything anything close to what you say should be avoided. Maybe I lack a bit of patience and am just eager to be myself again too quickly. I will ask my neurologist what he thinks of my situation. Maybe I should get another scan to confirm things are still going in the right direction. He did say I will get a Doppler early june. Again, thank you so much for these guidelines and for you fantastic video. I love to know exactly what is happening to me and have a general idea of the prognosis and treatments etc… I cannot say how much I appreciate finding this quality scientific presentation (I am a physics professor, I like facts, data and science and I talk about imagery in my classes!).

[@giann1208]

Hi thanks for your video and for us non medical field it's also very informative. I had a chiro treatment/neck manipulation 2 weeks ago but I still have the sensation of "floating", tingling sensation mostly on my right arm and thickening sensation of my hands and feet, also feels weird in my right eye not having the usual acuity. There's also a pain in the back of the neck after the chiro and I am on Baclofen for 2 weeks and it seems helping though I still feel discomfort in my neck. CT scan is unremarkable and having just neck spasm as findings but I just consulted another neuro and she wants to rule out artery dissection and my schedule of MRA for neck is next week and results might take another couple of days. My question is since it's going 3 weeks now after the injury, any possibilities that there will be a worsening of damages if any as I'm not really starting the treatment if I really have a dissection? Is time of the essence right now? And do I have a high chance of having stroke while waiting for the diagnosis? Your response is really appreciated!

[@theneurophile]

I’m sorry that you are experiencing difficulties. Unfortunately it is impossible to offer sound medical advice over the post on the internet. You should have a discussion with your doctor after a proper evaluation.

[@giann1208]

It is ok, really appreciate you took the time to respond. 🙂Does Cervical MRA Neck (blood vessels) should suffice and really show if there's indeed damages to the arteries?

[@theneurophile]

MRA is the neck with contrast can really be an excellent study to look for dissections, and if it is negative then the chance of dissection is low (provided that a special sequence to diagnose dissections was done).

[@giann1208]

Hopefully we can get significant findings even though weeks are already passed from injury date when it is the time of my MRI. Again I really appreciate your responses and thank you so much. ❤

[@samanthawhite9026]

I’m worried I could have a dissection, had an extreme sore neck about two weeks ago could barely move my head side to side or back, but then I stretched my neck really hard to one side. Ever since I’ve been having pain on the left side of my neck and werid headaches. Should I go to the ER or am I overreacting. I have bad health anxiety

[@theneurophile]

It is probably best to start by seeing a Neurologist to get a neurological examination. Most neck pain is NOT dissection. Dissections are actually quite rare.

[@beepboop9519]

What about this but in the right artery?

[@theneurophile]

What are you referring to?

[@TisMeBc]

Really curious if this is what I have, but this has been going on for a few years. Back in 2019 i was on a ride at an amusement park that got weirdly wild out of no where and i banged my head around quick wildly Later that night i had a visual aura for the first time followed by what seemed like a migraine and nausea associated to a migraine. that went on until i got blue light glasses and reduced light but still happened every week or so, completely flooring me. Fast-forward to today, 2023 and I still get this but rarely. it is caused by light exclusively and wearing sunglasses outside of my bedroom at all times seemed to be the only way to remedy the onset of the aura, but now the aura comes followed by a loss of being able to speak or remember names or form sentences, a numbness in my arms and face and pain behind one eye and a really bad migraine once those symptoms subside (30 min to an hour later) The migraine lasts, a few hours and a dull headache is present for a few days afterword's. But this all started with the roller coaster back in 2019. I have been treating this like a migraine since that day but maybe the migraine is a symptom of this? But I have heard that this heals on its own after some time, it hasn't for me. Doctors I have gone too seem to treat this by saying, take advil when you get a migraine and leave it at that; but Maybe its all because I said I think its migraines from the looking into it that I did and they never fact checked me? What are your thoughts? really curious if this fits the build and ive been barking up the wrong tree these last few years, id really like if it was this because then i wouldn't feel like im essentially boned and left to just figure out this on my own. I would at least have a cause and potential plan instead of being here stranded on a cliff having to fight to get the time of day from doctors who just nod and give me more pills to take after the migraine starts instead of caring enough to help determine why they are starting

[@theneurophile]

I am sorry that you are having troubles. It’s very difficult to diagnose people in an internet post. That being said, 4 years of pain with a dissection is highly unlikely.

[@TisMeBc]

@@theneurophile Thats fair, i went to the er and got some tests done and it isnt an active dissection at the very least so likley something else, kinda puts me in two worlds, 1 hand im happy im not activly having strokes on the other hand i have no clue what to do now and no leads as to what it could be

[@sergeyshchurko9541]

A fracture of the articulation of the sphenoid bone with the base of the skull is quite possible. In this case, the venous outflow of blood is disrupted. A situation in which doctors are powerless to help.:(

[@sergeyshchurko9541]

This pathology is best seen on 3D reconstructions: kzbin.info/www/bejne/d5CrnIikaK52bZI

[@ricardosilva6167]

Wanderley classes

[@theneurophile]

?

[@athamas1294]

I've had pain in the left side of my neck for past 8 months and I'm really worried about experiencing carotid dissection. I've been doing some yoga exercises in last couple of days but heard that yoga itself can cause carotid dissection. I just don't know what to do. I'm hopeless right now

[@theneurophile]

My fear is that when people listen to this lecture, they will all think they have dissections. In truth, dissection is a very rare condition. If you a worried, please see a doctor for a proper examination.

[@the7thfalsestart]

Hi, Dr. Rybinnik, your speech pattern is like this, some of the words are not completely pronounced especially at the end of each phrase which makes it difficult to understand and it looks like you are rushing to finish the lecture as quickly as possible.

[@theneurophile]

Thank you for the feedback. I’m always trying to get better.

[@the7thfalsestart]

@@theneurophile you are too humble to write a reply to my view, but apart from the speech pattern, If I were a neuro med student, I would learn under you and you would be my best teacher/prof. You are one of the best I've ever listened to and I have that much love for neuro and I miss the med life. 😐😞