II. 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

III. Causes

IV. 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. 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

V. 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

VI. Imaging

VII. Management

VIII. 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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