Tear in the tunica intima allowing blood between the inner and outer layers producing luminal stenosis, complete occlusion or clot embolism compromising blood supply to the brain

Accounts for nearly a quarter of strokes in young patients

Spontaneous: Associated with Ehlers Danlos, Marfan’s, fibromuscular dysplasia

Traumatic: Head injury, RTA, chiropractic manipulation

Horner’s syndrome, scalp tenderness, pulsatile tinnitus, cranial neuropathies and subarachnoid hemorrhage 

Imaging: CT or MRA.

Formal cerebral angiography is the gold standard investigation standard investigation  

Medical: Aspirin or warfarin 

Surgical: Angioplasty and stenting may be considered with dissection presenting 

with recurrent thromboembolism

Extracranial dissections have a better prognosis than intracranial types. 50% of cases have no neurological deficit. 4% mortality.

Ischaemic stroke