Dissection of the major arteries in the neck is an important and probably underdiagnosed cause of stroke and craniocervical head pain. The aim of treatment is to prevent neurological deficit and further strokes . The mechanism of ischaemia after dissection probably results from distal microemboli. Medical treatment aimed at reducing propagation of clot and distal embolisation has included use of antiplatelet drugs and anticoagulation. Early anticoagulation with heparin seems to reduce the chance of a complete stroke developing. Anticoagulation is recommended with intravenous heparin as soon as possible after the start of symptoms and diagnosis. Anticoagulation may be worth starting even as long as one month after presentation. Provided there are no contraindications on computerised tomography of the brain, anticoagulation should probably also be started even after neurological signs have appeared, as there is a tendency for strokes after dissection to follow a "stuttering" pattern. Anticoagulation is usually continued with warfarin until the vessel has recanalised, as determined by repeated Doppler ultrasound studies. Recanalisation may occur at any time from two days after presentation, but it may still not have occurred as long as 18 months later. The prognosis for other features of cervical arterial dissection is good. Most cranial nerve palsies recover completely and cranial pain usually resolves within three to four days, although in some patients it may become chronic. Please consult a neurologist for further details . Hope this helps you . Take care and regards !
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