Carotid Artery Dissection

Abstract

Among the large variety of cerebrovascular syndromes, carotid artery dissections remain often under-recognized. Many patients present with minor or transient symptoms, some with local pain only, and some are asymptomatic. A useful rule is that the coincidence of any local pain in neck or face with an ipsilateral Horner's syndrome preceding transient or persistent retinal or cerebral ischemic symptoms should alert physicians--notably those treating emergencies--to rule out an underlying dissection of the ipsilateral carotid artery. In most cases the extracranial part of the carotid artery is affected; therefore, this review will focus on this main subgroup of patients. We review the pathological anatomy, as well as possible underlying causes, clinical features, diagnostic tools, differential diagnosis, treatment options, and outcome data.

Internal carotid artery dissection: an unusual cause of postpartum headache

“…The fibers to the sweat glands of the face travel with the external carotid artery and are typically spared. 7,8 Ipsilateral bruit may be an early sign of ICAD. 7,22 Ipsilateral focal neurologic signs and symptoms are most often delayed and may indicate cerebral ischemia or infarction, cranial nerve palsy, or retinal ischemia.…”

“…7,22 Ipsilateral focal neurologic signs and symptoms are most often delayed and may indicate cerebral ischemia or infarction, cranial nerve palsy, or retinal ischemia. 7,8 In one series of 43 patients presenting with headache, the median duration of delay to the appearance of other manifestations of ICAD was 96 h (range one hour to 90 days). 16 Our patient presented with bilateral headache, seen in just over 20% of cases.…”

“…On the other hand, approximately 32% of ICAD cases present with a persistent headache alone. 16 Noninvasive imaging techniques are preferred, 8 and magnetic resonance angiography of the head and neck is as sensitive and specific as standard angiography for the detection of carotid artery dissection. 43,44 Treatment of carotid artery dissection focuses on anticoagulation to prevent thrombus formation on the injured endothelial surface and to avoid secondary embolism.…”

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

“…58,63 Treatment with Coumadin for 6 months-1 year has traditionally been advocated, with a target international normalized ratio of 2-3. 33,55 In a study on the treatment of blunt CA injury, anticoagulation was suggested to be the treatment of choice when dissection or pseudoaneurysm was diagnosed.…”

Antithrombotic Treatment for Acute Extracranial Carotid Artery Dissections: A Meta-Analysis

“…2 CAD is the most common cause of stroke in males under 45 years of age, 3 and has an associated mortality of up to 5% with a full resolution occurring in excess of 90% of cases. 4 CAD is associated with trauma, aneurysm, hypertension, and atherosclerosis. 5 Presentation can vary from incidental findings of asymptomatic disease to cerebrovascular events, regional pain, and Horner's syndrome.…”