Spontaneous Internal Carotid Artery Dissection Research Articles

Internal carotid artery dissection in a community. Rochester, Minnesota, 1987-1992.

Cervical internal carotid artery dissections are diagnosed with an increasing frequency, but reliable epidemiologic data are not available. The aim of this study was to determine the incidence rate of spontaneous cervical internal carotid artery dissection in a defined population. Using the medical record linkage system used for epidemiologic studies in Rochester, Minn, all patients diagnosed with spontaneous cervical ICA dissection for 1987 through 1992 were identified. A total of 10 patients with spontaneous cervical internal carotid artery dissection (6 women and 4 men; mean age, 44 years) were identified. For the period 1987 through 1992, the average annual incidence rate for all ages was 2.6 per 100,000 (95% confidence intervals, 0.9 to 4.2). This study, for the first time, provides incidence rates for spontaneous cervical internal carotid artery dissections. No diagnoses were made before 1987, probably reflecting an increased awareness of the disorder among physicians.

Traumatic and spontaneous extracranial internal carotid artery dissections: Mokir B. J Neurol 1990; 237: 356-61

Traumatic and spontaneous extracranial internal carotid artery dissections: Mokir B. J Neurol 1990; 237: 356-61

Horner's Syndrome Secondary to Spontaneous Carotid Dissection With Normal Angiographic Findings

Spontaneous dissection of the internal carotid artery is an uncommon disorder that is almost always associated with angiographic evidence of dissection. 1 We report a case of Horner's syndrome secondary to spontaneous subadventitial internal carotid artery dissection associated with normal angiographic findings. Magnetic resonance imaging (MRI) demonstrated the subadventitial dissection. Report of a Case. —A 57-year-old hypertensive man complained of a droopy left upper eyelid and mild scalp tenderness. One week earlier, he had developed generalized weakness, postural dizziness, and nausea. Several days later, he developed a dull ache around his left eye, cheek, and anterior aspect of the neck, as well as a faint metallic taste in his mouth. Examination revealed a blood pressure of 170/120 mm Hg. Visual acuity was 20/20 OU. There was 1-mm ptosis of the left upper eyelid. Pupillary testing demonstrated dilation lag in the left eye, with relative miosis that increased in dim illumination.

Spontaneous Internal Carotid Artery Dissection Shown by Magnetic Resonance Imaging

We have reported a case of spontaneous dissection of the internal carotid artery, with MRI and angiographic findings. We conclude that MRI is a beneficial noninvasive test for the detection and study of carotid artery dissection.

Headaches Due to Spontaneous Internal Carotid Artery Dissection Magnetic Resonance Imaging Evaluation and Follow Up

Spontaneous internal carotid artery (ICA) dissection is not an infrequent cause of headache and acute neurologic deficits in the younger population. Angiography has been the imaging modality of choice for both diagnosis and follow-up. The use of magnetic resonance imaging, (MRI), in conjunction with angiography, is described in three patients shown to have ICA dissection. Our clinical findings suggest that MRI may provide a less expensive, non-invasive, diagnostic and particularly a follow up modality in patients with headache and signs suggestive of ICA dissection.

Multivessel cervicocephalic and visceral arterial dissections: Pathogenic role of primary arterial disease in cervicocephalic arterial dissections

The origin and pathogenesis of spontaneous internal carotid artery dissections in most cases remain unclear. It is presumed that in many cases an underlying arterial disease may predispose the artery to the mural dissection. In about 15% of cases, there is angiographic evidence of fibromuscular dysplasia in carotid, vertebral, or renal arteries. Uncommonly, cases of cystic medial necrosis and, rarely, other arterial diseases have been reported. However, in the majority of cases, no arterial disease can be documented. Multivessel spontaneous dissections strongly suggest the presence of underlying arterial disease despite absence of any angiographic or laboratory findings pointing to any specific arteriopathy. In this communication, three cases of multivessel cervicocephalic and visceral arterial dissections are reported. Angiographic and laboratory data gave no clues to the nature of the underlying arterial disease. Further clinical observations and histopathologic studies, when possible, as well as biochemical studies should provide more insight into the origin and pathogenesis of the spontaneous arterial dissections.

Traumatic and spontaneous extracranial internal carotid artery dissections

Seventy patients with spontaneous and 21 with traumatic extracranial internal carotid artery dissections were studied clinically and angiographically with mean follow-ups of 64 (spontaneous group) and 40 months (traumatic group). Sixty percent of the patients in the spontaneous group and 71% in the traumatic group also had follow-up angiograms. In traumatic dissections aneurysms were common, significantly fewer aneurysms resolved or became smaller and fewer stenoses resolved or improved, whereas more stenoses progressed to occlusion. Traumatic dissections were more likely to leave the patients with neurological deficits. A significantly higher percentage of the patients with spontaneous dissections were asymptomatic at follow-up compared with the traumatic group. Although both spontaneous and traumatic dissections of extracranial internal carotid arteries mostly carry a good prognosis, the outcome may be somewhat less favorable for the traumatic group.

Cerebrovascular disease in Ehlers-Danlos syndrome type IV.

We describe two patients with cerebrovascular complications of Ehlers-Danlos syndrome type IV. A 16-year-old girl with spontaneous internal carotid artery dissection and a 46-year-old woman with aneurysmal subarachnoid hemorrhage and multiple aortic dissections were both deficient in collagen type III, analyzed in cultured skin fibroblasts. To our knowledge, spontaneous carotid artery dissection associated with collagen type III deficiency has not been reported previously. Early clinical recognition of this syndrome is of great importance in view of the hazards of angiography and surgery. Collagen type III deficiency plays a role in the pathogenesis of intracranial saccular aneurysms and may also be involved in the pathogenesis of carotid cavernous fistulas and dissections of the cervical arteries.

Multiple cranial neuropathy as a feature of internal carotid artery dissection.

The traditional presentation of spontaneous internal carotid artery dissection includes ipsilateral hemicranial headache, oculosympathetic paresis, and contralateral focal cerebral ischemic deficits. However, we describe two cases with multiple cranial nerve involvement ipsilateral to the dissection as the principal feature. The first patient, a 36-year-old man, had involvement of the 9th, 10th, 11th, and 12th cranial nerves. The second case was a 53-year-old man with abnormalities of the 5th, 7th, 9th, 10th, and 12th cranial nerves. In both, magnetic resonance imaging revealed a ring-like area of abnormal signal intensity surrounding the carotid artery at the skull base. Carotid angiography was consistent with the suggestion of dissection on the magnetic resonance studies in both cases. The patients recovered without anticoagulation. Internal carotid artery dissection may thus present with multiple cranial nerve palsies, which could be mistaken for an infiltrating tumor of the skull base. Magnetic resonance imaging is useful in identifying the condition.

Spontaneous Cervical Carotid Artery Dissection

The authors report a patient with spontaneous high cervical internal carotid artery dissection and a severe reversible ischemic deficit. Successful treatment consisted of 5 months of continuous intravenous heparin using an implantable infusion device. The details of this therapy are described, and alternative therapeutic modalities are discussed.

Bronchodilator and cardiac effects of isoprenaline, orciprenaline, and salbutamol aerosols in asthma.

Carotid artery dissection is a rare entity, and most cases are attributable to causative factors, which include trauma and local malignancy. The vast majority of dissections present with cerebral infarct; those few that present with local mass effect and respiratory compromise may deteriorate rapidly, requiring urgent resuscitation and consideration of endotracheal intubation, which is often dangerous and/or impossible. The case of a spontaneous internal carotid artery dissection in an otherwise healthy young man, leading to gross mass effect and eventual fatal airway obstruction, is presented here. The need for a high index of suspicion for cervical vascular injury in cases of neck injury (even trivial), known head and neck malignancy/irradiation, or coagulopathy is highlighted. Patients presenting with unilateral neck swelling and symptoms related to mass effect must be assumed to have progressive airway obstruction, and difficult intubation should be anticipated.