Talk:Vertebral artery dissection/GA1

GA Review

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I have read the article and it is very good. I plan to review it.

Reviewer: Garrondo (talk) 16:01, 4 January 2011 (UTC)

Thank you. Will chomp through them at a steady pace over the next few days. JFW | T@lk 20:13, 4 January 2011 (UTC)

Some (minor) comments:

Lead

•  Done No mention of the prognosis and history sections. I miss at least a line on them.
•  Done No mention of headache as symptoms while in signs and symptoms receives great importance.

Classification

•  Done I miss the section. I believe it would be a great section to have a small overview and include some of the info on the arterial disecctions, similarities and differences with carotid disecctions and cervical dissections
  • • I've created something very short, most of which is redundant with the rest of the content (but provides some structure). I'm not sure if this is the place to explain in great detail what other arteries may dissect, e.g. aortic dissection, as they are different though related diseases. JFW | T@lk 22:44, 5 January 2011 (UTC)

This and all other comments should be taken as suggestions, if you feel that adding such a section does not add much to the article simply get rid of it :-). Nevertheless I feel that as it is now (at the begining of the article) makes it easier to later understand content.

Signs and symptoms

•  Done I have added a missing internal link to headache.
•  Done Others may experience unsteadiness or lack of coordination due to involvement of the cerebellum: How about a link to ataxia
• There are no images in the section. Maybe the lead image in Horners sydrome article can be added.
  • • That image is pretty poor quality. No better on Commons. I can't immediately think of a better image. JFW | T@lk 22:44, 5 January 2011 (UTC)
• It may be characterized by a different, usually severe headache;: Not clear: different to what?
  • • The headache of SAH is typically quite severe. I'm struggling to summarise all the symptoms of SAH in a single sentence. JFW | T@lk 21:59, 4 January 2011 (UTC)
• Some give a figure of multiple vessel dissection as high as 30%: Some sounds quite ambiguous.
  • • I wanted to include the much higher figure given by Campos-Herrera, but with the caveat that it was really very high. JFW | T@lk 21:45, 4 January 2011 (UTC)

Causes

•  Done The spontaneous section is a bit difficult to digest due to the many disorders named in it and not explained. Maybe a line could be added for the two most common ones (Ehlers–Danlos syndrome type 4 and more rarely Marfan's syndrome) explaining what they consist in.
  • • I've added a review by a highly esteemed Belgian clinical genetics group that covers both conditions, and elaborated a bit on both conditions. JFW | T@lk 22:23, 6 January 2011 (UTC)
•  Done It has been difficult to prove this association statistically: Not clear whether it refers to the latter (infection), the former (mild trauma) or both.

Mechanism

• Preliminary note: I feel there are clearly two marked parts: one on descriptive anatomy, which serves well as an introduction, and then properly mechanism of the disease
  • • The anatomy section on its own would have made a short section - too short for its own level 3 header. JFW | T@lk 21:45, 4 January 2011 (UTC)
•  Done I believe this paragraph: The vertebral artery supplies a number of vital structures in the posterior cranial fossa, such as the brainstem, the cerebellum and the occipital lobes. The brainstem harbors a number of vital functions (such as respiration) and controls the nerves of the face and neck. The cerebellum is part of the diffuse system that coordinates movement. Finally, the occipital lobes participate in the sense of vision should be moved to the beginning of the section since it is talking more about normal anatomy than the disorder and it would fit better after the similar paragraph at the beginning.
•  Done Other studies have indicated that low-grade inflammation: low-grade is not internally linked neither explained and it is not lay-language (I for example do not know its meaning).

Diagnosis

•  Done How about internally linking stenosis?
•  Done The caption of the image is quite technical: I would link every technical term, even if alreadly linked in other places of the article. Moreover: gadolinium not linked anywhere in the article. Also maybe it could be simplified: probably age and sex of patient, indication of coronal cut, and the subtype of the syndrome are not needed.

Treatment

•  Done How about an image? (An image of some of the medications used such as aspirin?)

Since the aim of the image is to make nicer the article I believe that an image of actually the pills (not sure if there is one) would be much more "cheering up".

• Actually agree completely. I found a nice one on Commons. We won't mention the fact that the tablets shown are probably a higher dose than the 75-100 mg usually prescribed in stroke! JFW | T@lk 22:41, 6 January 2011 (UTC)

•  Done The sentence Thrombolysis is the administration of an analog of tissue plasminogen activator (such as urokinase or alteplase). This activates plasmin, which enzymatically destroys blood clots. is quite difficult to follow, even with the internal links.

Prognosis

•  Done SCAD should appear first time in the article it is used in brackets.
  • • It was a fossil from edits made by another editor. I have removed it completely as the abbreviation is not in widespread use. JFW | T@lk 21:45, 4 January 2011 (UTC)

Epidemiology

•  Done From 1994 to 2003, incidence increased threefold; this has been attributed to increased use of modern imaging modalities rather than a true increase: 3 times the word increase in a single sentence (and one more in the following one): any alternatives?

History

• It is quite short and centred in a single individual... I suppose there is not much more in reliable sources.
  • • I was thrilled that Campos referred to Fisher's original descriptions! It would otherwise have been nigh-impossible to find better content. I think Fisher's authority as a stroke physician led to immediate recognition of the syndrome. JFW | T@lk 22:44, 5 January 2011 (UTC)

I supposed so... It will have to stay as it is then. :-)

•  Done Fisher made a number of other contributions to the then-nascent field of stroke medicine: I know the section is short, but even so this sentence is irrelevant to the article.
  • • I'll get rid of it. JFW | T@lk 21:45, 4 January 2011 (UTC)

I believe that is all.--Garrondo (talk) 17:04, 4 January 2011 (UTC)

I've addressed all above concerns. Looking forward to the finishing touches. JFW | T@lk 22:23, 6 January 2011 (UTC)

You have done a great job (I expected no less :-). The article is well written, factually accurate and verifiable, broad in its coverage, neutral and stable: a clear GA.