Internal carotid artery dissection with different interventions and outcomes: two case reports

Abstract

Spontaneous internal carotid artery dissection (ICAD) is a rare disease and an important cause of stroke in young patients. The presentation of ICAD is variable and atypical. We have used three-dimensional T1-weighted volume isotropic turbo spin-echo acquisition to help diagnose ICAD. ICAD should be considered in young patients presenting with relevant symptoms in an emergency setting. We herein report ICAD with an unexplained onset in two patients. Neither had a history of large or small cervical trauma, but both had a history of hypertension. The first patient was a 33-year-old man who presented with upper extremity numbness and mobility impairment, and the second patient was a 40-year-old man with onset of visual impairment. There were no obvious triggers in either case. Both patients were diagnosed with ICAD by blood vessel examination. However, their prognoses differed. The first patient recovered after endovascular therapy, whereas the second patient was successfully managed with medical treatment. ICAD can cause different symptoms depending on where the dissection occurs. Clinicians must be aware of the different clinical manifestations of ICAD, make the correct diagnosis in a timely manner, make appropriate treatment plans according to the patient’s condition, and strive for timely recanalization of the blood vessels.

From the Squat Rack to the Emergency Department: Internal Carotid Artery Dissection Following Heavy-Weight Squats

“…Like in our patient, it usually occurs 2-3 cm superior to the bifurcation of the carotid artery [10]. The pathophysiology of artery dissection is due to an abnormality in the carotid artery's vascular layers, resulting in blood seeping into a false lumen and creating an initial flap closing off distal circulation [2][3][4]. As seen in this patient, a clear radiological indicator of a carotid artery dissection is the presence of an intimal flap and double lumen, which occurs due to the formation of an intramural hematoma.…”

“…Patients with ICAD may exhibit vague symptoms, but over 50% may also experience localized neurological symptoms caused by retinal or cerebral ischemia, such as Horner syndrome or cranial nerve paralysis. While many patients may not show any symptoms, it is crucial to maintain a high level of suspicion when risk factors are present to prevent additional complications [4]. Our patient displayed a classic symptom known as amaurosis fugax, characterized by temporary episodes of blindness caused by diminished blood flow to the retina.…”

“…In a case series of two cases by Dharmasaroja et al [10], possible causative mechanisms and associations were described for sports-related ICAD. Despite the rarity of these cases, they have been documented, and efforts to comprehend the exact mechanism are ongoing [3,4]. In this regard, we report the case of a healthy young Asian American male who experienced an ICAD during a 130 kg squat session.…”

“…Some studies have demonstrated a 1.72 in 100,000 annual incidence [2]. Despite this, it is the most common cause of stroke in the young, accounting for about 23% of strokes in individuals under 50 [2][3][4]. There have been reports linking ICAD with weightlifting or intense exercises, although the exact relationship between these activities and ICAD is not well understood [5][6][7].…”