Spontaneous cervical artery dissection: from risk factors toward pathogenesis.

The pathogenesis of a cervical artery dissection (CAD) remains unknown in most cases.1,2 Dissections are usually classified as either traumatic or spontaneous.3 However, mechanical trauma did not appear to be an important and frequent cause for the development of CAD, neither in clinical nor in histopathological studies. Chiropractic maneuver, for instance, was repeatedly discussed as a risk factor for CAD, but its pathogenetic effect could be proven only in a minority of cases.4 Signs of mechanical damage could not be observed in the majority of preparations in a histopathological study of 50 dissected carotid arteries.5 As a result, factors other than mechanical were increasingly taken into consideration in the pathogenesis of cervical artery dissections. Several constitutional risk factors have been associated with nontraumatic, spontaneous cervical artery dissection (sCAD).