Diagnosing intra-cranial and cervical artery dissection using MRI as the initial modality.

Dissection of cranial and cervical arteries is a relatively frequent clinical condition. However, it is difficult to diagnose a dissection when patients present with relatively mild symptoms. Various radiological techniques are used as diagnostic tools. This study analyzed retrospectively the characteristics of cranial and cervical artery dissections using "MR first concept", with MRI as the first-choice diagnostic modality for all new patients with neurological symptoms. The patients who were admitted in Ohnishi neurological center between January 2001 and December 2014 were included. MRI was used as the initial investigation for all new patients, including those with mild symptoms such as headache or vertigo only. The patients were divided into carotid group and vertebral group. The statistical comparison was performed between these two groups. A total of 164 patient cases were analyzed. In 44 (26.8%) and 120 (73.2%) patients, dissection occurred in the carotid group and vertebral group, respectively. Concerning the type of onset, 52 patients presented with only subjective symptoms accompanied with ischemic or hemorrhagic lesions, 97 patients with ischemic symptoms and 15 patients with subarachnoid hemorrhage. There were statistically significant differences between the carotid and vertebral groups in terms of hemiparesis, aphasia, history of trauma, headache and vertigo. Patients with only a headache and those with no ischemic features had no worsening symptoms. The symptom of headache or neck pain only is more frequent than previously reported. The "MR first concept" would prove useful for early diagnosis of dissections and early treatment.