Carotid Artery Dissection

Aka: Carotid Artery Dissection

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II. Epidemiology

  1. Internal Carotid Artery Dissection is the most common cause of stroke in age <40 years old

III. Pathophysiology

  1. Most common Cervical Artery Dissection is of the Carotid Artery at 2-3 cm above Carotid Artery bifurcation
  2. Extracranial Internal Carotid Artery crosses over anterior Cervical Spine at C2-C3, at 2-3 cm above bifurcation

IV. Causes

  1. See Cervical Artery Dissection

V. Findings

  1. Initial
    1. Ipsilateral Neck Pain
      1. Often present at onset
    2. Headache (most common)
      1. Sudden onset, unilateral, constant, throbbing Headache
      2. Thunderclap Headache may be present
    3. Horner Syndrome
      1. Typically partial Horner Syndrome (Miosis and Ptosis without Anhidrosis)
      2. Acute Painful Horner's Syndrome is found in up to 58% of internal carotid artey dissections
  2. Next
    1. Anterior cerebral ischemia
    2. Retinal ischemia
  3. Associated findings
    1. Carotid Bruit
    2. Focal neurologic deficits
      1. Often insidious or subtle developing over days to weeks

VI. Complications

  1. Anterior circulation Cerebrovascular Accident
  2. Expanding Hematoma
  3. Arterial Hemorrhage
  4. Aneurysm formation
    1. Local mass effect (esp. compression of CN 9, CN 10 and CN 12)
    2. Subarachnoid Hemorrhage

VII. Imaging

  1. See Cervical Artery Dissection

VIII. Management

  1. See Cervical Artery Dissection

IX. References

  1. Hussein and Leiman (2022) Crit Dec Emerg Med 36(8): 4-8
  2. Blum (2015) Arch Neurosci 2(4) +PMID:26478890 [PubMed]

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