Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections, Olmsted County, 2002–2020
| Female (n=68) | Male (n=76) | P | |
| Age at dissection, mean±SEM | 47.3±2.0 | 52.5±1.8 | 0.0605 |
| Race† | 0.701 | ||
| Asian | 3 (4.4) | 3 (3.9) | |
| Black/African American | 1 (1.5) | 0 (0) | |
| White | 63 (92.6) | 69 (90.8) | |
| Other | 1 (1.5) | 2 (2.6) | |
| Unknown/not reported | 0 (0) | 2 (2.6) | |
| Ethnicity† | 0.371 | ||
| Hispanic or Latina/o | 0 (0) | 2 (2.6) | |
| Not Hispanic or Latina/o | 67 (98.5) | 71 (93.4) | |
| Unknown/not reported | 1 (1.5) | 3 (3.9) | |
| Aetiology of dissection | 0.341 | ||
| Major trauma | 7 (10.3) | 14 (18.4) | |
| Minor trauma | 13 (19.1) | 11 (14.5) | |
| Spontaneous | 48 (70.6) | 51 (67.1) | |
| Location† | 0.081 | ||
| Common carotid | 1 (1.5) | 4 (5.3) | |
| Internal carotid | 28 (41.2) | 43 (56.6) | |
| Vertebral | 36 (52.9) | 28 (36.8) | |
| Both (carotid and vertebral) | 3 (4.4) | 1 (1.3) | |
| Medical comorbidities | |||
| Migraine | 38 (55.9) | 12 (15.8) | < 0.001** |
| Hypertension | 18 (26.5) | 31 (40.8) | 0.070 |
| Hyperlipidaemia | 18 (26.5) | 33 (43.4) | 0.034* |
| Diabetes mellitus† | 3 (4.5) | 10 (13.2) | 0.086 |
| Smoking, current or history | 25 (36.8) | 33 (43.4) | 0.416 |
| Connective tissue disorder or fibromuscular dysplasia† | 5 (7.4) | 2 (2.6) | 0.255 |
| Presenting symptoms and signs | |||
| Asymptomatic | 10 (14.7) | 13 (17.1) | 0.695 |
| Neck pain | 27 (39.7) | 16 (21.1) | 0.015* |
| Headache | 31 (45.6) | 37 (48.7) | 0.710 |
| Horner’s syndrome | 11 (16.2) | 8 (10.5) | 0.317 |
| Transient ischemic attack (TIA) | 12 (17.6) | 7 (9.2) | 0.135 |
| Stroke | 18 (26.5) | 32 (57.9) | 0.049* |
| Pulsatile tinnitus† | 8 (11.8) | 3 (3.9) | 0.115 |
| Dissection features | |||
| Occlusion | 14 (20.6) | 22 (28.9) | 0.247 |
| Intramural haematoma | 20 (29.4) | 16 (21.1) | 0.247 |
| Dissecting pseudoaneurysm | 21 (30.9) | 13 (17.1) | 0.052 |
| Intraluminal thrombus† | 1 (1.5) | 5 (6.6) | 0.126 |
| Tapering off stenosis | 16 (23.9) | 26 (34.7) | 0.160 |
| Recurrent TIA/stroke† | 3 (4.5) | 7 (9.5) | 0.332 |
| Recurrent dissection† | 8 (11.8) | 1 (1.3) | 0.013* |
| mRS at 2 years† | 0.403 | ||
| 0 | 33 (48.5) | 26 (34.2) | |
| 1 | 22 (32.4) | 27 (35.5) | |
| 2 | 4 (5.9) | 9 (11.8) | |
| 3 | 2 (2.9) | 4 (5.3) | |
| 4 | 6 (8.8) | 6 (7.9) | |
| 5 | 0 (0) | 0 (0) | |
| 6 | 1 (1.5) | 4 (5.3) |
Values are represented as n (%) unless otherwise specified. Categorical variables were analysed using χ square or Fisher’s exact based on sample size. Continuous variables were analysed using unpaired t-test.
*p<0.05; **p<0.001.
†Fisher’s exact testing performed due to sample size.
mRS = modified Rankin Scale for neurologic disability; 0: no symptoms at all, 1: no significant disability despite symptoms; able to carry out all usual duties and activities, 2: slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance, 3: moderate disability; requiring some help, but able to walk without assistance, 4: moderately severe disability; unable to walk and attend to bodily needs without assistance, 5: severe disability; bedridden, incontinent and requiring constant nursing care and attention, 6: dead.