• Tineke Sikkema, Maarten Uyttenboogaart, J Marc C van Dijk, Rob J M Groen, Jan D M Metzemaekers, Omid Eshghi, Aryan Mazuri, Nicolaas A Bakker, and Gert-Jan Luijckx.
• *Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; ‡Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; §Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
• Neurosurgery. 2015 Jun 1;76(6):663-70; discussion 670-1.

BackgroundIntracranial artery dissections (IADs) are an important cause of stroke or subarachnoid hemorrhage (SAH). Outcome of IAD in the anterior circulation or presentation without SAH is rarely investigated and might be different.ObjectiveTo evaluate the clinical features and prognosis of patients with IAD, with special emphasis on the location (anterior vs posterior circulation) and clinical presentation (SAH or cerebral ischemia).MethodsBetween January 1998 and May 2012, 60 patients with IAD were included in this single-center cohort study. Clinical features, functional outcome, mortality, and prognostic factors were evaluated. Unfavorable functional outcome was defined as a modified Rankin scale score of 3 to 6.ResultsIn 18 patients (30%), IAD was located in the anterior circulation. At a median follow-up of 6.4 months, 35.3% of patients with IAD in the anterior circulation had an unfavorable functional outcome vs 39.0% in patients with IAD in the posterior circulation (P = .79). Forty-two patients (70%) presented with SAH. Clinical presentation with SAH was not significantly associated with poor functional outcome (41.5% vs 29.4%, P = .39). Low Glasgow Coma Scale score on admission (odds ratio, 0.72, P = .003) and older age (odds ratio, 1.04, P = .04) were independent predictors of unfavorable functional outcome. Mortality rate was 13% and did not significantly differ with location or clinical presentation.ConclusionLow Glasgow Coma Scale score on admission and older age were independent predictors of unfavorable functional outcome. IAD presenting with SAH was not significantly associated with poor functional outcome.

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