Dissection of the Common and External Carotid Artery

Abstract

extension of the neck. Another report [2] describes 54 patients with blunt and sharp carotid artery injuries but without mentioning dissections. In 20% of the patients, the ECA was affected, but the trauma included stab wounds and gunshot wounds. Campbell et al. [3] describe a case of ECA pseudoaneurysm from hyoid bone fracture. In 1994, Minion et al. [4] report also a case of a pseudoaneurysm of the ECA and performed a review of the literature. They found only 6 other cases of ECA pseudoaneurysms. In a case report of Chen et al. [5] , a spontaneous dissection of the CCA is described and a review of the literature from 1960 to 2003 revealed a further 8 patients with CCA dissection; no patient with a dissection of the ECA was found. Up to now, there has been no systematic investigation about the frequency and incidence of dissections of the CCA and ECA. In a comprehensive review by Brandt [6] , dissections of the CCA and/or ECA are not mentioned, due to their rareness. Out of a series of 126 cervical artery dissections (78 patients with dissection of the internal carotid artery, 46 patients with dissection of the vertebral artery and 2 patients with a combined dissection) registered in our Department from 1992 to 2001 [7] , there was no case Case Report A 37-year-old man was admitted to the Department of Neurology with left-sided neck pain. The pain had started 6 days before admission after a foot kick to the left side of the patient’s neck by his son while playing. He went to his general practitioner who performed an ultrasound examination of the brain-supplying arteries. Ultrasound examination was suspicious of a mural hematoma in the common carotid artery (CCA) and the patient was sent to our department. We performed a neurological examination, a CT angiography, a 3-tesla MRI scan of the neck arteries and an ultrasound of the brain-supplying arteries. The neurological examination in our department was completely normal apart from a mild miosis on the left side. We immediately performed a cranial CT scan including CT angiography which demonstrated a small mural swelling of the carotid bulb continuing to the external carotid artery (ECA) ( fi g. 1 ). The mural swelling of the ECA led to a mild stenosis of the vessel. We diagnosed a cervical artery dissection and the patient was put on intravenous heparin. The ultrasound examination 3 days later revealed an echolucent structure at the same site of the vessel without any visible intimal lesion ( fi g. 2 ). The reduction of the vessel lumen of the ECA was less than 50%. A 3-tesla MRI scan of the neck was performed. The MRI scan demonstrated an intramural hematoma of the left carotid bulb and of the ECA ( fi g. 3, 4 ). The internal carotid artery was not affected and no intimal lesion could be found. During the hospitalization, the left-sided miosis disappeared completely. The neck pain was treated symptomatically. Since no intimal lesion could be found, the patient was put on aspirin 100 mg for antiplatelet aggregation.