Incidence of internal carotid artery dissection in the community of Dijon.

Giroud, Maurice; Fayolle, H.; André, N; Dumas, R; Becker, F.; Martin, Dale G.; Baudoin, N.; Krause, Danielle

doi:10.1136/jnnp.57.11.1443

Cited by 196 publications

(91 citation statements)

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“…Spontaneous dissection of the cervical internal carotid artery (sICAD) is a significant cause of stroke in young adults (Lisovoski and Rousseaux, 1991;Nedeltchev et al, 2005). The published annual incidence of sICAD ranges from 1.7 3 per 100,000 (Giroud et al, 1994;Lee et al, 2006;Schievink et al, 1993). In part due to its often favourable outcome with treatment using anticoagulant drugs, as well as its unspectacular presentation and often delayed recognition, the initiating cause is unknown (Schievink, 2001).…”

Section: Introductionmentioning

confidence: 99%

The role of the carotid sinus in the reduction of arterial wall stresses due to head movements—potential implications for cervical artery dissection

Callaghan

Soellinger

Baumgartner

et al. 2009

Journal of Biomechanics

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The role of the carotid sinus in the reduction of arterial wall stresses due to head movements--potential implications for cervical artery dissection Abstract Spontaneous dissection of the cervical internal carotid artery (sICAD) is a major cause of stroke in young adults. A tear in the inner part of the vessel wall triggers sICAD as it allows the blood to enter the wall and develop a transmural hematoma. The etiology of the tear is unknown but many patients with sICAD report an initiating trivial trauma. We thus hypothesised that the site of the tear might correspond with the location of maximal stress in the carotid wall. Carotid artery geometries segmented from magnetic resonance images of a healthy subject at different static head positions were used to define a path of motion and deformation of the right cervical internal carotid artery (ICA). Maximum head rotation to the left and rotation to the left combined with hyperextension of the neck were investigated using a structural finite element model. A role of the carotid sinus as a geometrically compliant feature accommodating extension of the artery is shown. At the extreme range of the movements, the geometrical compliance of the carotid sinus is limited and significant stress concentrations appear just distal to the sinus with peak stresses at the internal wall on the posterior side of the vessel following maximum head rotation and on the anteromedial portion of the vessel wall following rotation and hyperextension. Clinically, the location of sICAD initiation is 10-30 mm distal to the origin of the cervical ICA, which corresponds with the peak stress locations observed in the model, thus supporting trivial trauma from natural head movements as a possible initiating factor in sICAD. BM-D-08-00610ROriginalThe role of the carotid sinus in the reduction of arterial wall stresses due to head movements -potential implications for cervical artery dissection

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Section: Introductionmentioning

confidence: 99%

The role of the carotid sinus in the reduction of arterial wall stresses due to head movements—potential implications for cervical artery dissection

Callaghan

Soellinger

Baumgartner

et al. 2009

Journal of Biomechanics

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“…10 During the last 15 years, it has become evident that dissections of the cervicocephalic arteries are a major cause of ischemic stroke in young and middle-aged people. [11][12][13][14] In patients younger than 50 years, ICADs cause about 10% of strokes, 15 the percentage rising to 20% in patients aged 30 or younger. 16 According to two community-based studies, ICAD has an annual incidence of 2.6 to 2.9 per 100000 persons.…”

Section: Commentsmentioning

confidence: 99%

“…16 According to two community-based studies, ICAD has an annual incidence of 2.6 to 2.9 per 100000 persons. 15,17 The most common manifestations of ICAD are ipsilateral headache and/or facial pain, oculosympathetic palsy, and focal cerebral ischemic events. Visual symptoms including amaurosis fugax and positive visual phenomena resembling scintillating scotomata may occur, 18 as seen in our patient.…”

Section: Commentsmentioning

confidence: 99%

“…Since its first description in 1971, 20 spontaneous bilateral ICAD was thought to be very rare. 15,21 Schievink et al, however, recently showed in a large series of 200 consecutive patients with spontaneous dissection(s) of cervical arteries that multivessel dissection was relatively common and that, in fact, 18% of patients had bilateral ICAD. 10 In contrast to our patient, however, in most with bilateral ICAD only one dissected carotid artery was symptomatic.…”

Section: Commentsmentioning

confidence: 99%

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Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay

1997

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A 36-year-old man with a history of migraine without aura, presented with recurrent bouts of severe headache, perception of flashing lights in both visual fields, and transient bilateral neurological deficits. In view of his history, migraine with aura was considered. Ancillary investigations showed bilateral extracranial internal carotid artery dissection. This case illustrates that when attacks of severe headache with scotomata and transient bilateral neurological deficits occur in a patient with a history of migraine, the diagnosis of carotid artery dissection should be considered, especially when the pattern of headache is different or when some clinical characteristics have not been experienced previously.Key words: carotid artery, dissection, migraine Abbreviations:ICA internal carotid artery, ICAD internal carotid artery dissection (Headache 1997;37:109-112) Repeated bouts of headache associated with transient visual, motor, and speech disturbances in young or middle-aged patients with migraine may be suggestive of migraine with aura. 1 However, when the pattern of headache or neurological symptoms are different from previous attacks, another cause may be involved, including dissection of one or more cervicocephalic arteries. 2,3 This is illustrated in the following patient. CASE HISTORYA 36-year-old, right-handed man had a history of migraine without aura. Two weeks before admission, he suddenly experienced severe left-sided occipital headache radiating to the retro-orbital region. There was no history of trauma or physical exertion. The headache resolved spontaneously within 2 days. One week later, he suddenly noted flashing lights in both eyes, followed by markedly decreased visual acuity, light-headedness, left periorbital headache, and weakness of the extremities. Weakness persisted for a few minutes on the right side, and for 2 hours on the left side. The headache progressively waned within 24 hours. Five days later, left-sided frontal headache, light-headedness, and bilaterally decreased visual acuity recurred, accompanied by bilateral weakness of the extremities, more pronounced on the left. The neurological signs disappeared within 30 hours.Two days later, bifrontal headache and perception of flashing lights in both visual fields recurred, accompanied by left hemiparesis and dysarthria. As the left-sided weakness had not disappeared within 48 hours, he was referred to the emergency department. Physical examination showed a blood pressure of 200/120 mm Hg, dysarthria, left hemiparesis, left sensory and visual neglect, generalized hyperreflexia, and bilateral extensor plantar responses. Ophthalmological examination was normal.Blood chemistry and hematology were normal. There was no evidence of coagulopathy, inflammatory, or autoimmune disease. Electro-cardiogram and chest x-ray were normal. Brain CT showed a right parietal infarction.Color duplex ultrasound showed no stenosis at the level of the carotid bifurcations, but was suggestive of a high-grade stenosis at the most distal part of the righ...

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“…The annual incidence of spontaneous ICA dissections is 2.6 (Schievink et al1993) and 2.9 per 100 000 (Giroud et al 1994). The incidence may be even higher; the condition probably remains unrecognised in a number of patients, because only two-thirds of the patients will develop cerebral or retinal ischemic symptoms.…”

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confidence: 99%

The ophthalmology of internal carotid artery dissection

Kerty¹

1999

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: Carotid dissection is an important cause of cerebral and retinal ischemic symptoms, especially in young adults. This article presents a patient material and also includes a review of the ophthalmologic signs and symptoms of carotid dissection. Material and methods: Twenty-eight patients with spontaneous dissection of the extracranial internal carotid artery dissection underwent a neuro-ophthalmological examination. Results: Twenty-three patients had oculosympathetic paresis. Two experienced transient monocular blindness; in one the episodes were provoked by sitting up from a supine position. One patient presented with a monocular visual field defect, due to posterior ischemic neuropathy, and two others with homonym hemianopia. Diplopia, caused by an incomplete VIth cranial nerve palsy was recognised in one. Conclusion: All but one patient presented with detectable ophthalmologic symptoms or signs. Very often the ophthalmologist is the first medical contact for patients with internal carotid artery dissection. The condition is serious, and a prompt evaluation and treatment is indicated to prevent irreversible sequelae.

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Incidence of internal carotid artery dissection in the community of Dijon.

Cited by 196 publications

References 5 publications

The role of the carotid sinus in the reduction of arterial wall stresses due to head movements—potential implications for cervical artery dissection

The role of the carotid sinus in the reduction of arterial wall stresses due to head movements—potential implications for cervical artery dissection

Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay

The ophthalmology of internal carotid artery dissection

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