Ultrasound Findings in Spontaneous Carotid Artery Dissection The Value of Duplex Sonography

Sturzenegger, Matthias

doi:10.1001/archneur.1991.00530220079023

Cited by 72 publications

(29 citation statements)

References 33 publications

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“…Insonation of the bifurcation and the proximal ICA revealed no structural abnormalities in half of the cases, probably because the dissection frequently began in a more distal arterial segment that was difficult to visualize by ultrasound imaging techniques. DeBray et al 9 found various abnormalities in 78% of the echotomograms, whereas, corresponding to our experience, Sturzenegger 12 emphasized that only typical abnormalities of the Doppler signal suggest the correct diagnosis in ICAD with normal B-mode scans.…”

supporting

confidence: 68%

“…All patients had the first ultrasonographic examination within 3 days after onset of symptoms. Nineteen (39%) patients had a history of a minor head or neck trauma (n=7) or other possibly provocative situations, such as a variety of sports activities, surgical procedures, chiropractic therapy, vomiting, or coughing (n= 12), that preceded the onset of symptoms for an average interval of 7 days. In 2 patients the dissection was bilateral; in 3 patients the carotid dissection was associated with a unilateral vertebral artery dissection.…”

Section: Methodsmentioning

confidence: 99%

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Noninvasive monitoring of internal carotid artery dissection.

Steinke

Rautenberg

Schwartz

et al. 1994

Stroke

173

130

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Background and Purpose Internal carotid artery dissection has increasingly been reported as a cause of transient ischemic attack or stroke. However, scarce data exist on the natural history of the arterial lesions and the temporal profile of recanalization.Methods We followed 48 patients with 50 angiographicalry confirmed internal carotid artery dissections by sequential duplex Doppler studies in 2-to 4-day intervals during the first weeks after the onset of symptoms and after 4 weeks in 1-to 2-month intervals for up to 2 years. We assessed sonographic features as well as the frequency and time course of resolution.Results Initial Doppler findings were abnormal in all patients, most of whom (68%) presented with a characteristic bidirectional high-resistance Doppler signal in the internal

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supporting

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Noninvasive monitoring of internal carotid artery dissection.

Steinke

Rautenberg

Schwartz

et al. 1994

Stroke

173

130

View full text Add to dashboard Cite

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“…Upper dissections or upper false aneurysms are not seen, nor is dysplasia in the acute phase of dissection. 4 CDFI cannot be used alone because it may fail to detect stenoses at higher levels.…”

Section: Resultsmentioning

confidence: 99%

“…One or more of these local signs, associated with cerebral ischemic symptoms, were present in 40% of the cases. J Ultrasound Med 13:659-664,1994 CWD Technique CWO was performed using the following devices: ''Doppler Mesures Systemes" scanner using 4 MHz probe and "SPEAD electroniques" scanner using 4 MHz probe. The technique of extracranial investigation has been reported previously.…”

Section: Clinical Featuresmentioning

confidence: 99%

Ultrasonic features of extracranial carotid dissections: 47 cases studied by angiography.

Bray¹,

Lhoste²,

Dubas³

et al. 1994

Journal of Ultrasound in Medicine

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The purpose of this prospective study was to assess the value of continuous wave Doppler velocimetry, standard duplex scanning and color Doppler flow imaging in the diagnosis of carotid dissections. From 1975 to 1993, 42 patients (mean age, 44 +/‐ 14 years) were admitted to the University Hospital of Angers for a carotid dissection studied first by ultrasonography, then defined by angiography. Five cases were bilateral. Continuous wave Doppler examination revealed signs of severe obstruction of the carotid arteries in 96% of the cases (occlusion, extensive submandibular tight stenoses, significant slowdowns in the carotid and ophthalmic vessels, retrograde ophthalmic blood flow). Standard duplex scanning suggested dissection in 72% of the cases (tapering stenoses or occlusion, segmental ectasis, tubular vessel, peripheral residual channel, or rare irregular "membrane"). Color Doppler flow imaging suggested a dissection in 82% of the cases. This method has the advantage of underlining the peripheral channel, the double lumen, and the dissecting hematoma, which often is hypoechoic. The ultrasonic methods (continuous wave Doppler combined with color Doppler flow imaging) failed only when they are performed late and when moderate or segmental intrapetrosal dissections were present. These ultrasonic investigations would thus appear to be useful for early diagnosis of carotid dissections.

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“…5,22 Prompt differentiation between migraine and ICAD is important, as in ICAD. anticoagulants or platelet antiaggregation agents should be considered.…”

Section: Commentsmentioning

confidence: 99%

Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay

1997

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A 36-year-old man with a history of migraine without aura, presented with recurrent bouts of severe headache, perception of flashing lights in both visual fields, and transient bilateral neurological deficits. In view of his history, migraine with aura was considered. Ancillary investigations showed bilateral extracranial internal carotid artery dissection. This case illustrates that when attacks of severe headache with scotomata and transient bilateral neurological deficits occur in a patient with a history of migraine, the diagnosis of carotid artery dissection should be considered, especially when the pattern of headache is different or when some clinical characteristics have not been experienced previously.Key words: carotid artery, dissection, migraine Abbreviations:ICA internal carotid artery, ICAD internal carotid artery dissection (Headache 1997;37:109-112) Repeated bouts of headache associated with transient visual, motor, and speech disturbances in young or middle-aged patients with migraine may be suggestive of migraine with aura. 1 However, when the pattern of headache or neurological symptoms are different from previous attacks, another cause may be involved, including dissection of one or more cervicocephalic arteries. 2,3 This is illustrated in the following patient. CASE HISTORYA 36-year-old, right-handed man had a history of migraine without aura. Two weeks before admission, he suddenly experienced severe left-sided occipital headache radiating to the retro-orbital region. There was no history of trauma or physical exertion. The headache resolved spontaneously within 2 days. One week later, he suddenly noted flashing lights in both eyes, followed by markedly decreased visual acuity, light-headedness, left periorbital headache, and weakness of the extremities. Weakness persisted for a few minutes on the right side, and for 2 hours on the left side. The headache progressively waned within 24 hours. Five days later, left-sided frontal headache, light-headedness, and bilaterally decreased visual acuity recurred, accompanied by bilateral weakness of the extremities, more pronounced on the left. The neurological signs disappeared within 30 hours.Two days later, bifrontal headache and perception of flashing lights in both visual fields recurred, accompanied by left hemiparesis and dysarthria. As the left-sided weakness had not disappeared within 48 hours, he was referred to the emergency department. Physical examination showed a blood pressure of 200/120 mm Hg, dysarthria, left hemiparesis, left sensory and visual neglect, generalized hyperreflexia, and bilateral extensor plantar responses. Ophthalmological examination was normal.Blood chemistry and hematology were normal. There was no evidence of coagulopathy, inflammatory, or autoimmune disease. Electro-cardiogram and chest x-ray were normal. Brain CT showed a right parietal infarction.Color duplex ultrasound showed no stenosis at the level of the carotid bifurcations, but was suggestive of a high-grade stenosis at the most distal part of the righ...

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Ultrasound Findings in Spontaneous Carotid Artery Dissection The Value of Duplex Sonography

Cited by 72 publications

References 33 publications

Noninvasive monitoring of internal carotid artery dissection.

Noninvasive monitoring of internal carotid artery dissection.

Ultrasonic features of extracranial carotid dissections: 47 cases studied by angiography.

Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay

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