Imaging of carotid artery dissection

Abstract

A32-year-old woman presented to the emergency room complaining of a headache and blurred vision in her left eye. Two weeks before presentation she felt ‘sinus pressure’ and heard a swishing sound in her left ear associated with pain and tightness on the left side of her head, face, and neck, most prominent at the angle of the jaw. She sought emergent attention when she felt a ‘gritty sensation’ in her left eye and noted that her left eyelid was red and droopy. On evaluation vitals were normal. Her forehead showed no vasomotor or sudomotor changes. She had an injected left conjunctiva with miotic pupil (left 3 mm, right 5 mm) which was reactive to light and accommodation. Corneal fluorescein uptake and fundoscopic exam were normal. Vision was 20/20 in both eyes. Extraocular movements were normal, but the patient complained of pain in the left eye. The higher cortical, other cranial nerve, motor, sensory, and cerebellar functions were normal. Imaging studies showed a left internal carotid artery dissection extending up to the base of the skull. (Published: 16 July 2012) Citation: Journal of Community Hospital Internal Medicine Perspectives 2012, 2 : 18645 - http://dx.doi.org/10.3402/jchimp.v2i2.18645