Dysautonomia From Bilateral Carotid Artery Dissection

Abstract

The mechanisms of dysautonomia from carotid artery dissection were discussed recently in Circulation . A case was presented of a 49-year-old woman with a history of hypertension and vasovagal syncope who developed abrupt slurred speech and left hemiplegia.1 She had a right internal carotid artery dissection and right cerebral hemispheric infarction involving the insular cortex. During her hospitalization, the patient had episodes of severe bradycardia that Dulay et al1 attributed to “mechanical pressure to an already sensitive carotid sinus from thrombus secondary to a dissection of the internal carotid.” Sarikaya et al2 argued that disrupted descending autonomic pathways from the infarcted insular cortex were responsible. Right-sided insular lesions are known to cause bradyarrhythmias.3 We present a case of bilateral carotid artery dissection in which dysautonomia occurred in the absence of cortical damage. A 47-year-old right-handed woman with rheumatoid arthritis experienced symptoms of an apparent upper respiratory infection with a persistent cough after the syndrome resolved. After …