Journal of Neurology, Neurosurgery, and Psychiatry 1985;48: 111-121 Fatal intracranial arterial dissection: clinical pathological correlation

SUMMARY The clinical pathological features of fatal arterial dissection confined to the intracranial vessels are described. Three patients with anterior circulation dissections presented with focal ischaemic neurological deficits and pathological examination of involved vessels revealed a dis-section plane between internal elastic lamina and media accompanied by intravascular throm-bosis. Three of four patients with posterior circulation dissections had clinical pathological fea-tures of subarachnoid haemorrhage and at necropsy had transmural dissections. In contrast to previous reports, primary vasculopathies either degenerative or inflammatory were not identified in affected vessels. The pathogenesis of intracranial arterial dissection is discussed and the clinical features are correlated with the pathological abnormalities. Spontaneous dissection of the intracranial vessels leading to stenosis or occlusion of the vessel lumen has been recognised with increasing frequency as an important cause of focal ischaemic neurological dis-ease.'-5 In contrast, until recently little attention has been focused on spontaneous intracranial arteria