Imaging of Carotid Dissection

Hakimi, Ryan; Sivakumar, Sanjeev

doi:10.1007/s11916-019-0741-9

Cited by 48 publications

(53 citation statements)

References 44 publications

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“…Given the sudden onset of neck pain, the possibility of a vascular dissection should be considered, and we thought vertebral artery dissection was the most possible diagnosis when she was transferred. MRI is also good diagnostic tool for vascular disease [10,11].…”

Section: Discussionmentioning

confidence: 99%

Young Woman with Sudden-Onset Neck Pain and Quadriplegia: a Case Report

Ota

Ogawa

Fujii

et al. 2021

SN Compr. Clin. Med.

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Introduction Sudden-onset quadriplegia is a neurologic emergency that requires immediate management. Anterior spinal artery syndrome (ASAS) is rare, but can cause sudden-onset quadriplegia. Magnetic resonance imaging (MRI) is an essential imaging modality for diagnosing ASAS. Case Presentation A 31-year-old woman without previous medical history was transferred to our facility for further workup of sudden-onset neck pain with quadriplegia. Diffusion-weighted imaging (DWI) revealed hyperintense signals predominantly in grey matter with a decreased apparent diffusion coefficient (ADC). These findings strongly suggested ASAS with spinal cord infarction. Edaravone, heparin, and aspirin with steroid pulse therapy were immediately initiated. Twelve days in an intensive care unit was required for dyspnea. Symptoms gradually resolved with rehabilitation, but the patient was wheelchair-bound without bladder control and was transferred to a rehabilitation facility on hospital day 48. Conclusion A combination of DWI with ADC mapping of the spine should proceed as soon as possible to ensure appropriate management. Early treatment with edaravone, aspirin, and steroid pulse therapy may prove beneficial for ASAS.

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Section: Discussionmentioning

confidence: 99%

Young Woman with Sudden-Onset Neck Pain and Quadriplegia: a Case Report

Ota

Ogawa

Fujii

et al. 2021

SN Compr. Clin. Med.

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show abstract

“…It is not suitable for application in all patients. Instead, CTA and MRA are considered non-invasive imaging approaches to detect CAD and can be used in most patients [12,13,30]. Unfortunately, these modalities of angiography are not able to detect intramural hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of CAD, ICAD, or VAD was confirmed by two stroke neurologists and a neuroradiologist based on clinical manifestations and radiological features of the cases. Both cervical artery dissection and intracranial artery dissection were included in the analysis if patients presented with an intramural hematoma, intimal flap, double lumen, long tapering stenosis, artery occlusion that recanalizes in an irregular aneurysmal dilation or stenosis, or irregular aneurysmal dilation with rapid changes in morphology or associated with focal stenosis on magnetic resonance imaging and angiography (MRI, MRA), or computed tomography angiography (CTA), or digital subtraction angiography (DSA) [9,12,13]. Patients were excluded if they had co-occurrence of CAD and VAD, or if they had dissection for iatrogenic causes, or if dissection or injury of other supra-aortic arteries were identified, including aortic dissection.…”

Section: Participantsmentioning

confidence: 99%

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Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection

Chen

Xing

et al. 2020

BMC Neurol

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Background Cervicocerebral artery dissection is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. Methods All cases diagnosed with cervicocerebral artery dissection, ICAD, or VAD were identified through a medical records database, between January 2010 and January 2020. Baseline characteristics, predisposing factors, and radiological features of ICAD versus VAD were compared. Results A total of 140 patients with cervicocerebral artery dissection were included in the study, including 84 patients in the ICAD group and 56 in the VAD group. The mean age of patients in the ICAD and VAD groups was 43.37 ± 14.01 and 41.00 ± 12.98 years old, respectively. Patients with ICAD were more likely to be men compared with VAD (85.71% vs. 67.86%, p = 0.012). The frequency of hypertension, diabetes, smoking, drinking, and cervical trauma did not differ between ICAD and VAD. Dissections of ICAD were more frequently at the extracranial portions of the artery compared with those of VAD (70.24% vs. 44.64%, p = 0.003). In contrast, dissections of VAD were more common in the intracranial artery (55.36% vs. 29.76%, p = 0.003). Radiologically, double lumen (36.90% vs. 19.64%, p = 0.029) and intimal flap (11.90% vs. 1.79%, p = 0.029) were more frequently observed in ICAD than in VAD, and dissecting aneurysms were less frequent (13.10% vs. 26.79%, p = 0.041). Conclusions The distributions of cervical and intracranial artery dissections were different between ICAD and VAD. The frequencies of radiological features detected in patients with ICAD and VAD also differed.

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“…However, the speed of image acquisition is slow and MRA is not always feasible in intensive care unit (ICU) patients. Conversely, CTA is widely available, offers rapid image acquisition and compares favorably with DSA at a sensitivity of 64–100% and specificity of 67–100% [6].…”

Section: Discussionmentioning

confidence: 99%

Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report

Boßelmann

Poli

2019

Ultrasound J

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BackgroundCarotid artery dissection due to extension of aortic dissection (CAEAD) is a severe complication of acute aortic dissection. The risk of ischemic stroke is increased. Early sonographic detection and repeat evaluation are necessary to guide clinical management.Case presentationA 58-year-old male patient presents with sudden, tearing retrosternal pain. Point-of-care carotid ultrasound is used to establish the diagnosis of CAEAD. We describe a number of sonographic features and compare ultrasound to other imaging modalities.ConclusionsBedside carotid ultrasound enables rapid, sensitive and safe hemodynamic assessment, especially in critically ill patients.

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Imaging of Carotid Dissection

Cited by 48 publications

References 44 publications

Young Woman with Sudden-Onset Neck Pain and Quadriplegia: a Case Report

Young Woman with Sudden-Onset Neck Pain and Quadriplegia: a Case Report

Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection

Sonographic features of carotid artery dissection due to extension of aortic dissection: a case report

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