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• W2895848721 abstract "HomeStrokeVol. 36, No. 11A Systemic Review of the Risk Factors for Cervical Artery Dissection Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBA Systemic Review of the Risk Factors for Cervical Artery Dissection Armin J. Grau and Florian Buggle Armin J. GrauArmin J. Grau Department of Neurology, Klinikum der Stadt Ludwigshafen a.Rh. Bremserstr, Ludwigshafen, Germany Search for more papers by this author and Florian BuggleFlorian Buggle Department of Neurology, Klinikum der Stadt Ludwigshafen a.Rh. Bremserstr, Ludwigshafen, Germany Search for more papers by this author Originally published13 Oct 2005https://doi.org/10.1161/01.STR.0000185695.67188.f7Stroke. 2005;36:2340Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 13, 2005: Previous Version 1 To the Editor:We read with interest the review by Rubinstein et al1 on risk factors for cervical artery dissection. In a case-control study, we had analyzed the role of recent infection on cervical artery dissection.2 This study was referenced by the authors; however, our main findings were not correctly cited by the authors. In univariate analyses, recent infection and high-social status were significantly more common, and smoking was significantly less common in patients with cervical artery dissection (CAD) than in patients with cerebral ischemia of other origin. In conditional logistic regression analysis, infection within 1 week (odds ratio, 2.87; 95% CI, 1.18 to 7.00) and high-social status (odds ratio, 6.54; 95% CI, 1.88 to 22.7) remained significantly associated with CAD. Because coughing, sneezing, and vomiting that often occur during infection could explain the association between CAD and acute infectious disease, we systematically assessed the frequency of these mechanical factors. Recent cough, sneezing, and vomiting tended to be reported more often by CAD patients (60.5%) than by control patients (41.4%; P=0.06). In multivariate analysis, infection within 1 week, (odds ratio, 2.42; 95% CI, 1.01 to 5.8; P=0.046) but not cough, sneezing, or vomiting (odds ratio, 1.60; 95% CI, 0.67 to 3.8; P=0.29), was associated with CAD. This indicates that mechanical factors during infection do not explain the association between CAD and infections.Therefore, the data given by Rubinstein et al1 in the abstract and the text regarding infection are not correct and require revision together with conclusions in their review. From our study and the results by Guillon et al,3 so far recent infection has to be regarded as a risk factor for cervical artery dissection. Furthermore, high-socioeconomic status may be another factor that is associated with the risk of CAD, although this certainly requires additional investigations.Rubinstein et al1 mentioned the possibility of a selection bias in our study. Our case-control study2 was not part of a population-based register; however, it was based on consecutive patients in both groups. Given the fact that almost all of the younger patients with cerebral ischemia in the catchment area are treated in the University Center, the risk of selection bias can be rated as very low. In summary, 2 well-performed case-control studies found an independent association between recent infection and CAD that was not explained by factors such as mechanical stress to cervical arteries.2,31 Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systemic review of the risk factors for cervical artery dissection. Stroke. 2005; 36: 1575–1580.LinkGoogle Scholar2 Grau A, Brand T, Buggle F, Orberk E, Mytilineos J, Werle E, Conradt C, Krause M, Winter R, Hacke W. Association of cervical artery dissection with recent infection. Arch Neurol. 1999; 56: 851–856.CrossrefMedlineGoogle Scholar3 Guillon B, Berthet K, Benslamia L, Bertrand M, Bousser MG, Tzourio C. Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke. 2003; 34: e79–e81.LinkGoogle ScholarstrokeahaStrokeStrokeStroke0039-24991524-4628Lippincott Williams & WilkinsResponse:Rubinstein Sidney M., Peerdeman Saskia, van Tulder Maurits, and Haldeman Scott01112005We would like to thank Drs Grau and Buggle for their interest in our article. They raise 2 important issues.Their first objection may have to do with clarity of the text. We are not suggesting that the weak association refers to the relationship between dissection and the mechanical factors associated with infection, such as coughing, sneezing, or vomiting, but rather, the association between infection and dissection, even when these mechanical stressors are controlled for. Therefore, our article also agrees with the authors that recent infection may be an important risk factor, which is an association noted by others. However, this association may not be very strong. High socioeconomic status may also be an important risk factor and perhaps a subject for additional study; however, we did not identify any case-control studies that have confirmed this relationship.Regarding the second point, case-control studies are notoriously sensitive to selection bias. Our objection was not whether patients were selectively identified (ie, consecutive), but rather that the control group chosen (ie, cerebral ischemia) may be inappropriate. Quite simply, controls must be a representative sample of the study base and must have an equal chance to develop the target disease as the cases. If not, it is a case of com-paring apples with oranges. The mechanism of cerebral ischemia is quite clearly different from dissection, and we suggest that the risk factors may also differ (eg, “vascular risk factors”), which is why we proposed that healthy subjects might be a more suitable control. Otherwise, this may result in a potential overestimation of risk.Note: This article was originally published online as a “systemic review.” However, this was a typographic error and should have read, “a systematic review.” eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zuluaga-Gómez M, Giraldo-Campillo D, González-Arroyave D, Ardila C and Kao S (2022) Ischemic Stroke Secondary to a Stab Wound to the Neck in a Young Adult, Case Reports in Medicine, 10.1155/2022/9365947, 2022, (1-5), Online publication date: 18-Oct-2022. Li Z, Liu J, Wang X, Liu X, Sun Q, Du Y and Yin L (2020) Bilateral vertebral artery dissection complicated by posterior circulation stroke in a young man, Medicine, 10.1097/MD.0000000000022822, 99:44, (e22822) Bodenant M and Leys D (2018) Infarti cerebrali del soggetto giovane, EMC - Neurologia, 10.1016/S1634-7072(18)41288-3, 18:4, (1-11), Online publication date: 1-Apr-2018. Jani V and Fessler R (2018) Cervical (Carotid and Vertebral) Artery Dissection Extracranial Carotid and Vertebral Artery Disease, 10.1007/978-3-319-91533-3_20, (241-251), . November 2005Vol 36, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000185695.67188.f7PMID: 16251528 Originally publishedOctober 13, 2005 PDF download Advertisement" @default.
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