Review article - Internal carotid artery dissection

Abstract

The purpose of this review is to increase the awareness of internal carotid artery dissection (ICAD), a potentially serious and probably underdiagnosed condition. ICAD is a not uncommon cause of stroke in young patients. ICAD may occur spontaneously or as a result of trauma. However, the "spontaneous" dissection is often preceded by a trivial trauma. The typical patient presents with ipsilateral headache or neck pain, ipsilateral Horner's syndrome and delayed ischemic symptoms from the ipsilateral hemisphere or retina. Conventional angiography, the gold standard for diagnosis, tends to be replaced by non-invasive diagnostic methods. There are no evidence-based guidelines for therapy although anticoagulation is most commonly used. The references are selected from the Medline database for the years 1966-1997.

Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective

“…Cranial nerve palsies and Horner's syndrome are often pathognomonic of ICA pathology, especially if the onset is acute. The hypoglossal nerve (CN XII) is the most commonly affected followed by the glossopharangeal (CN IX), vagus (CN X), or accessory (CN XI) 39,42 . However, all cranial nerves (except the olfactory nerve) can be affected 39 .…”

“…This dissection event can manifest in a number of signs and symptoms that are non-ischemic (i.e., somatic pain related to local injury). These local signs and symptoms can precede cerebral ischemia (TIA or stroke) or retinal ischemia by anything from less than a week to beyond 30 days 38,39 . There is, therefore, a period of time when a patient with ICA dissection may present to the manual therapist with signs and symptoms that may mimic a neuromusculoskeletal presentation 37 .…”

Disección traumática de la arteria carótida interna y embolismo cerebral en un jugador de fútbol. Reporte del primer caso.

“…Esta técnica diagnóstica es no invasiva y de mayor utilidad en trauma penetrante que en trauma cerrado (10). Las limitaciones incluyen: inaccesibilidad para evaluar la carótida interna intracraneal distal y el segmento proximal de la carótida común y la necesidad de la inmovilización cervical en trauma de alta energía (7); sin embargo, provee información indirecta sobre injurias distales ante la presencia de turbulencia, alteraciones del flujo o información directa de las estructuras in situ, además de su gran utilidad para el seguimiento (11,12). Dado su accesibilidad y bajo costo es una herramienta útil para el despistaje, sobre todo en países pobres como el nuestro.…”

Cerebral infarction caused by traumatic carotid artery dissection

“…[1] In addition to a detailed history and careful physical examination, duplex carotid ultrasound, CT, CT angiography, MRI, MR angiography, and conventional angiography are imaging studies that can be performed to diagnose traumatic ICAD. [7,8] The present case was referred to us with a diagnosis of acute embolic stroke although she had no signs of ischemia on her CT performed at the first hospital. A comprehensive neurologic exam could not be performed secondary to her depressed level of consciousness.…”