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Excerpt from Dissection, Carotid ArterySynonyms, Key Words, and Related Terms: carotid artery dissection, CAD, ischemic stroke, arteria carotis interna, internal carotid artery dissection, internal carotid artery, arteria carotis communis, common carotid artery dissection, common carotid artery, stroke, Marfan syndrome, fibrocystic dysplasia, subarachnoid hemorrhage, manipulation of neck, headache, transient ischemic attack, TIA, oculosympathetic paresis, amaurosis fugax, syncope, neck swelling, pulsatile tinnitus, Horner syndrome, miotic pupils, ptosis, facial anhydrosis, cranial nerve palsies, hemiparesis, carotid bruit, syphilis, smoking, Ehlers-Danlos syndrome type IV, cystic medial necrosis, fibromuscular dysplasia, atherosclerosis, oral contraceptives, motor vehicle accident, MVA Please click here to view the full topic text: Dissection, Carotid ArteryBackground: Carotid artery dissection is a significant cause of ischemic stroke in all age groups. Spontaneous carotid dissection can occur, most frequently in the fifth decade of life. Dissection of the internal carotid artery can occur intracranially or extracranially, with the latter being more frequent. Internal carotid artery dissection can be caused by major or minor trauma, or it can be spontaneous in which case genetic, familial, and/or heritable disorders are likely etiologies. Patients can present in a variety of settings, such as a trauma bay with multiple traumatic injuries; their physician's office with nonspecific head, neck, or face pain; or to the emergency department with a partial Horner syndrome. A high index of suspicion is required to make this difficult diagnosis. Sophisticated imaging techniques, which have improved over the last 2 decades, are required to confirm the presence of dissection. Early institution of antithrombotic treatment provides the best outcome.
Pathophysiology: Although the cause of internal carotid artery dissection remains elusive, mechanical forces (trauma, blunt injury, stretching) and underlying arteriopathies (Ehlers-Danlos syndrome IV, other connective tissue disorders/aberrations) alone, or in combination, account for most of the pathophysiology. Carotid artery dissection begins as a tear in the tunica intima or between the tunica media and tunica adventitia (possibly originating from the vasa vasorum). The blood under arterial pressure dissects along the artery to create an intramural hematoma, which can either narrow the carotid artery lumen or cause an aneurysmal dilatation. Both processes may cause stenosis or thromboemboli. The aneurysm resulting from an internal carotid artery dissection is a true, as opposed to a false, aneurysm because the wall is composed of blood vessel elements. Sometimes, the pathognomonic "intimal flap" may be noted with vascular imaging. Frequency:
Mortality/Morbidity: Spontaneous internal carotid artery dissection has a reported mortality rate of less than 5%, although the morbidity and mortality of internal carotid artery dissection due to blunt trauma may be much higher.
Sex: No gender-based difference exists for spontaneous internal carotid artery dissection. Age:
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