The causes of<unk>  can be grouped under two main categories, spontaneous and traumatic. Spontaneous Spontaneous cases are considered to be caused by intrinsic factors that weaken the arterial wall. Only a very small proportion (1–4%) have a clear underlying connective tissue disorder, such as Ehlers–Danlos syndrome type 4 and, more rarely, Marfan syndrome. However, ultrastructural abnormalities of the dermal connective tissue components are discernible in two out of three patients with spontaneous dissection. Ehlers–Danlos syndrome type 4, caused by mutations of the COL3A gene, leads to defective production of the collagen, type III, alpha 1 protein and causes skin fragility as well as weakness of the walls of arteries and internal organs. Marfan syndrome results from mutations in the FBN1 gene, defective production of the protein fibrillin-1, and a number of physical abnormalities including aneurysm of the aortic root. There have also been reports in other genetic conditions, such as osteogenesis imperfecta type 1, autosomal dominant polycystic kidney disease and pseudoxanthoma elasticum, α1 antitrypsin deficiency and hereditary hemochromatosis, but evidence for these associations is weaker. Genetic studies in other connective tissue-related genes have mostly yielded negative results. Other abnormalities to the blood vessels, such as fibromuscular dysplasia, have been reported in a proportion of cases. Atherosclerosis does not appear to increase the risk. There have been numerous reports of associated risk factors for<unk> ; many of these reports suffer from methodological weaknesses, such as selection bias. Elevated homocysteine levels, often due to mutations in the MTHFR gene, appear to increase the risk of<unk> . People with an aneurysm of the aortic root and people with a history of migraine may be predisposed to<unk> . Vascular tortuosity or redundancy in young patients is associated with an increased risk of spontaneous dissection. Traumatic Traumatic<unk>  dissection may follow blunt trauma to the neck, such as in a traffic collision, direct blow to the neck, strangulation, or whiplash injury. 1–2% of those with major trauma may have an injury to the carotid or<unk>  arteries. In many cases of<unk>  dissection, people report recent very mild trauma to the neck or sudden neck movements, e.g. in the context of playing sports. Others report a recent infection, particularly respiratory tract infections associated with coughing. Trauma has been reported to have occurred within a month of dissection in 40% with nearly 90% of the traumas being minor. It has been difficult to prove the association of<unk>  with mild trauma and infections statistically. It is likely that many "spontaneous" cases may in fact have been caused by such relatively minor insults in someone predisposed by other structural problems to the vessels. A more likely theory, also as yet unproven, is that the low-energy traumatic dissections are actually spontaneous dissections brought to medical attention by the onset of neurological symptoms. These neurological events represent embolic phenomena due to loosening or breakdown of the clot at the site of the dissection, which can be triggered by low energy trauma or even occur spontaneously. The fragments travel within the arterial system downstream to the brain to cause stroke or stroke-like symptoms.<unk>  has also been reported in association with some forms of neck manipulation. There is significant controversy about the level of risk of stroke from neck manipulation. It may be that manipulation can cause dissection, or it may be that the dissection is already present in some people who seek manipulative treatment. At this time, conclusive evidence does not exist to support either a strong association between neck manipulation and stroke, or no association. However, the two most authoritative articles on the subject, recent literature reviews and analyses, conclude that although there exists an association between stroke from<unk>  and chiropractic adjustment, there is insufficient evidence to indicate that the adjustment caused the dissection. A recent meta-analysis of the published data on the topic also looked to apply Hill's criteria for assigning causation in biological systems to the relationship between chiropractic adjustment and cervical artery dissection, finding that the relationship did not fulfill the required criteria for causality.
Vertebral artery dissection
Cervical artery dissection
Carotid artery dissection
Posterior cerebral artery syndrome
Middle cerebral artery syndrome
Anterior cerebral artery syndrome
ROSAH syndrome
Pseudosubarachnoid hemorrhage