Internal carotid artery dissection: an unusual cause of postpartum headache

Waidelich, J.M.; Bullough, Alexandra S.; Mhyre, Jill M.

doi:10.1016/j.ijoa.2007.04.003

Cited by 20 publications

(20 citation statements)

References 44 publications

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“…Risk factors are thought to include migraine, hyperhomocysteinaemia, recent systemic infection, connective tissue disorders, vascular wall disorders, parturition and mechanical manipulations of the carotid artery. 36 As found in our patient, postpartum headache and acute ischaemic stroke are the most common symptoms. 37 One antepartum case and eight postpartum cases of carotid dissection have been reported.…”

Section: 22supporting

confidence: 68%

“…37 One antepartum case and eight postpartum cases of carotid dissection have been reported. 36,38 Diagnosis of carotid artery dissection or rupture depends on neurological examination, and can be confirmed by Doppler ultrasound, CT angiography or preferably magnetic resonance angiography. Therapeutic options are anticoagulant therapy, endovascular stenting and surgical repair.…”

Section: 22mentioning

confidence: 99%

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Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

Chapelle¹,

Schutte

Schuitemaker

et al. 2011

BJOG

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Objective To determine the incidence of maternal deaths attributable to vascular dissection and rupture in the Netherlands, and to assess clinical features, risk factors and the frequency of substandard care in the cases identified.Design Confidential enquiry into the causes of maternal deaths.Setting Nationwide in the Netherlands. Results A total of 23 maternal deaths attributable to vascular dissection and rupture were reported. In most cases the location was aortic (n = 13), followed by coronary (n = 4) and splenic (n = 3) arteries. Clinical features were various, but most women presented with sudden unexplainable pain. Risk factors were present in 14 cases (61%), with hypertension being most frequently reported in ten cases (43%). Substandard care was determined to have been received in 13 cases (56%), inadequate assessment of complaints and a delay in diagnosis being the most frequent problems identified.Conclusions Vascular dissection and rupture in pregnancy, although rare, carry a high risk of maternal and fetal morbidity and mortality. Because of the rarity of this condition and its variety in presentation, diagnosis is easily missed. A high index of suspicion when a woman presents with suggestive complaints, leading to an early diagnosis, may improve the prognosis for the woman and her child.Keywords Aneurysm, aortic dissection, carotid artery dissection, coronary dissection, hepatic artery dissection, iliac artery dissection, maternal mortality, pregnancy-related, splenic artery dissection, substandard care, vascular dissection, vascular rupture.Please cite this paper as: la Chapelle C, Schutte J, Schuitemaker N, Steegers E, van Roosmalen J on behalf of the Dutch Maternal Mortality Commitee. Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry. BJOG 2012;119:86-93.

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Section: 22supporting

confidence: 68%

Section: 22mentioning

confidence: 99%

Maternal mortality attributable to vascular dissection and rupture in the Netherlands: a nationwide confidential enquiry

Chapelle¹,

Schutte

Schuitemaker

et al. 2011

BJOG

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“…Only in two cases could the effect of positive intrathoracal pressure (Valsalva manoeuvre) during labour be dismissed because the childbirth was performed by the planned caesarean's section. In the other two cases, the labour was performed by caesarean's section after an unsuccessful vaginal delivery (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

Dynamic Nature of Postpartal Carotid Artery Dissection

Vukicevic¹,

Brkić

Ducic³

et al. 2016

Serbian Journal of Experimental and Clinical Research

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ABBREVIATIONS CCAD -craniocervical carotid artery dissectionCTA -computed tomography angiography DSA -digital selective angiography ICA -internal carotid artery MRA -magnetic resonance angiography АBSTRACT Craniocervical carotid artery dissection (CCAD) is an important cause of stroke in young adults, but it has rarely been reported as a cause of stroke in puerperium.We We report the case of a 27-year-old female with a hi i is s sof migraine who presented with unilateral left hea ad a a atransient episodes of dysphasia and right hemipar r re r sis ys after vaginal delivery. Th e fi rst symptoms started ed ed d ed six after the pro o o ol lo lo lo l ng ng ng ged ed ed ed childbirth. Th e fi rst magnetic c c c c resoangiogra a a a ap p ph p p y revealed ed d ed d d d d d dis is is is issection in the sup p up up upra a ra rac clinoid cavern n n no o ou o s se se se se segm gm g g g en en nt t t t of of of of of t the lef f f ft t t t t In In In nte te ternal al al al a c carotid artery . We fo fo fo o foll ll ll l lo o ow o ed d d d up the pa a a ati t t t en n n nt t t t t for two years and she had stabl l le e e e e co o o our u u se. During this time e e e, , , she had occlusion of the clinoid segment of the left ICA, with caudal extension e ext x x x x ra r r r cranial segment and re eca a analisation one month T T Two w w w m m m m mon onth th ths s la la late ter, r, s she he he h h had ad ad i int ntrac cranial extension with ti i i i ion n n n o o o of f f the left anterior cere e ebr br bra a al artery. During this s s she s su s s s ff ff ff ff ffer e e ed from two stroke e e e es s s s w w wi w w th minimal neurologim mp pa p irme m me me ment nt nt nt t a a and good clinic ic ic ca a al r r r r recovery. The pathop p phy hy hy hy hysi si si iol ol l ol log o og og ogy y y of of of C C CCA CA CA CA AD D D D appears to be multifactoVessel el el w w w wal al a a l injury r l l l elated to the Valsalva manoeuvre durbour, as wel l ll l l l as as as a h h h hemodynamic and hormonal changes of ssel wall related to pre e e egn gn gn gn g an a cy in a patient with a history graine, may be causes of p p po p p stpartum spontaneous crarvical artery dissection in h h

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“…2,3 Pregnancy-related carotid dissection with associated stroke has rarely been described. 4,5 Common clinical manifestations include neck pain, Horner's sydrome, and retinal or cerebral ischemia. 3 Pregnancy may increase the risk of carotid dissection due to vascular remodeling by matrix metalloproteinase enzymes that increase arterial diameter and compliance.…”

Section: Discussionmentioning

confidence: 99%

“…3 Pregnancy may increase the risk of carotid dissection due to vascular remodeling by matrix metalloproteinase enzymes that increase arterial diameter and compliance. 5 These changes combined with the physiologic changes of pregnancy including increased vascular volume and cardiac output may increase shear stress across the vessels and lead to dissection. Tearing of the carotid intima then leads to intramural hematoma with resultant narrowing of the arterial lumen.…”

Section: Discussionmentioning

confidence: 99%