Spontaneous Internal Carotid Artery Dissection: An Uncommon Cause of Recurrent Postpartum Headache

Stamboulis, Elefterios; Raptis, Georgios; Andrikopoulou, Athina; Arvaniti, Chrisa; Brountzos, Elias; Oikonomopoulos, Nikos; Stefanis, Leonidas; Voumvourakis, Konstantinos

doi:10.1111/j.1552-6569.2009.00387.x

Cited by 10 publications

(14 citation statements)

References 14 publications

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“…Pregnancy presents its own unique circumstances that may increase the risk of CAD. Vascular wall remodeling that results in increased vascular volume and compliance may make vessels more susceptible to dissection, while increased cardiac output and blood flow through the carotid arteries may lead to changes in shearing forces across the endothelial surface, resulting in greater risk for an intimal tear [ 11 , 17 , 18 ]. The hypercoagulable state of pregnancy contributes to development of thrombosis at the area of dissection, with subsequent development of embolism [ 11 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

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Resolution of Internal Carotid Dissection with Middle Cerebral Artery Occlusion in Pregnancy

Ulrich

Johnson

Jodry

et al. 2015

Case Reports in Neurological Medicine

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Introduction. Cervical artery dissection (CAD) is a common cause of stroke in younger patients. While the incidence of stroke in pregnancy is increasing, CAD remains a rare cause of ischemic stroke in the pregnant population, with only 30 cases described in the literature, most in the postpartum period. Methods. The case of a pregnant patient at 18 weeks of gestation presenting with CAD and ischemic stroke following intercourse is discussed. Discussion. CAD results from an intimal tear in the carotid artery, allowing accumulation of blood in the vessel wall. Stroke results from embolization of thrombogenic material in the wall. Etiology includes minor trauma, connective tissue disorders, or anatomic variations of the carotid artery. Most patients present with headache and/or neck pain, while ischemic symptoms are seen in at least 50% of patients. In the pregnant population, imaging with MRI or MRA of the head and neck aids in diagnosis. Once the diagnosis is made, patients are treated with either anticoagulation or antiplatelet medications. The optimal treatment in both pregnant and nonpregnant patients has not been well-studied. Conclusion. CAD is an important diagnosis to consider in a pregnant patient with persistent headache, especially if neurological symptoms are present. Imaging should be quickly obtained so treatment can be initiated.

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Section: Discussionmentioning

confidence: 99%

“…The hypercoagulable state of pregnancy contributes to development of thrombosis at the area of dissection, with subsequent development of embolism [ 11 , 17 ]. In addition, expulsive efforts in the second stage of labor may theoretically precipitate dissection [ 11 , 15 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Resolution of Internal Carotid Dissection with Middle Cerebral Artery Occlusion in Pregnancy

Ulrich

Johnson

Jodry

et al. 2015

Case Reports in Neurological Medicine

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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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“…Arterial dissection after childbirth is rare and usually occurs within a few weeks of delivery, [26][27][28][29] but the exact incidence is difficult to determine. Patients with connective tissue disorders and a history of neck trauma seem to be at a higher risk.…”

Section: Arterial Dissectionmentioning

confidence: 99%

Early Postpartum Headache: Case Discussions

Cardona¹,

Klein²

2011

Semin Neurol

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Headaches are a common complaint for most women during their lifetime, including gestation and puerperium. Tension-type headaches and migraine flare-ups are the most common headache complications after delivery, but the differential diagnosis of postpartum headache is broad. The clinician must distinguish common headache syndromes from dangerous causes of postpartum headache. We will focus on early postpartum headaches in the form of case discussions that will include clinical presentation, diagnostic criteria, and treatment.

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Spontaneous Internal Carotid Artery Dissection: An Uncommon Cause of Recurrent Postpartum Headache

Cited by 10 publications

References 14 publications

Resolution of Internal Carotid Dissection with Middle Cerebral Artery Occlusion in Pregnancy

Resolution of Internal Carotid Dissection with Middle Cerebral Artery Occlusion in Pregnancy

Dynamic Nature of Postpartal Carotid Artery Dissection

Early Postpartum Headache: Case Discussions

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