Carotid Artery Dissection

Epidemiology

A dissection is hemorrhage into the arterial wall. The etiology may be either traumatic or spontaneous. Traumatic dissections result from either blunt or penetrating trauma. Spontaneous, or atraumatic, dissections typically result from prolonged or rapid head turning, flexion, or extension or after physical exertion or strenuous activity. The cervical segment just distal to the carotid bifurcation is the most common site of an internal carotid dissection. The most common intracranial site of a carotid artery dissection is the supraclinoid carotid artery. There is an increased association between systemic disorders that cause dysplasia of the vessel wall (such as fibromuscular dysplasia) and spontaneous carotid dissection.

Clinical Features

The most common symptoms are headache or neck pain. These complaints occur in about 75% of affected patients. Other symptoms include retroorbital headache and Horner’s syndrome. Dissection is believed to cause between 2 and 3% of strokes in the general population and 5 to 20% of strokes in young patients.

Pathology

Bleeding into the arterial wall may be due to direct hemorrhage into the media from the vasa vasorum or secondary to an intimal tear. Hemorrhage into the media results in lumen narrowing whereas extension into the subadventitial plane may result in formation of a dissecting aneurysm. Intracranial dissection may result in subarachnoid hemorrhage.

Treatment