Carotid artery dissection

Carotid Artery Dissection

Diagram of the carotid arteries

Carotid artery dissection is a condition where there is a tear in the carotid artery wall. This can lead to a separation of the layers of the artery wall, creating a false lumen. This condition can result in stroke or transient ischemic attack (TIA) due to reduced blood flow or embolism.

Anatomy

The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and face. There are two carotid arteries: the left and the right. Each carotid artery divides into the internal and external carotid arteries. The internal carotid artery supplies blood to the brain, while the external carotid artery supplies blood to the face and neck.

Pathophysiology

In carotid artery dissection, a tear in the intima, the innermost layer of the artery, allows blood to enter the wall of the artery and split its layers. This can lead to the formation of a hematoma within the artery wall, which can narrow the artery and reduce blood flow. Additionally, the dissection can create a flap that can lead to embolization of clots to the brain, causing a stroke.

Causes

Carotid artery dissection can occur spontaneously or as a result of trauma. Spontaneous dissections may be associated with underlying connective tissue disorders such as Ehlers-Danlos syndrome or Marfan syndrome. Traumatic dissections can occur due to neck injuries, such as those sustained in car accidents or sports.

Symptoms

Symptoms of carotid artery dissection can vary but often include:

• Sudden onset of headache, often described as severe or "thunderclap"
• Neck pain
• Partial Horner's syndrome (ptosis, miosis, anhidrosis)
• Amaurosis fugax (temporary vision loss)
• Ischemic stroke symptoms, such as weakness or numbness on one side of the body, difficulty speaking, or facial droop

Diagnosis

Diagnosis of carotid artery dissection is typically made using imaging studies. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are commonly used to visualize the dissection and assess blood flow. Computed tomography angiography (CTA) is another imaging modality that can be used.

Treatment

Treatment of carotid artery dissection aims to prevent stroke and manage symptoms. Options include:

• Anticoagulation or antiplatelet therapy to prevent clot formation
• Surgical intervention or endovascular therapy in severe cases

Prognosis

The prognosis for carotid artery dissection varies. Many patients recover fully with appropriate treatment, but some may experience recurrent strokes or persistent neurological deficits.

Related pages

• Stroke
• Horner's syndrome
• Ehlers-Danlos syndrome
• Marfan syndrome