Spontaneous Carotid Artery Dissection with Cluster-Like Headache

Abstract

A case of carotid artery dissection in a 41-year-old-woman is described whose main symptom was cluster-like pain. The case is interesting for its atypical presentation with only two other like cases in the literature, and the site of dissection, localized in the intrapetrous curvature of the carotid artery. The case highlights the need for active co-operation between clinician and neuroradiologist during neuroimaging assessment which must be focused on the clinical evaluation of the individual patient so as to avoid error, particularly in atypical cases.

Segmental cavernous carotid ectasia in a patient with cluster-like headache

“…Though explicite criteria for CHL does not cite male gender, in our case this fact as well as presence of earlier cluster period and normal physical finding are consisted with diagnosis of CHL. CLH was also suspected due to the older age of our patient compared to typical age for CH (CH cluster periods characteristically start in the third decade of life, and very seldom before the age of 20, but average onset in CLH patients turns out to be at the age of 42.7 years [5]). Furthermore, our patient was a non-smoker, though smoking seems to be the most consistent lifestyle habit in patients with CH across studies [14], the most frequent trigger for CH was absent, and there was no data about periodicity characteristic of biorhythmic disorders.…”

“…An extended review of 156 symptomatic, cluster-like headache cases showed that the more frequent pathologies mimicking primary cluster headache were vascular disorders, followed by tumors and inflammatory infectious diseases [2]. Various vascular pathology involving trigeminovascular system can trigger CLH: pseudoaneurysm within cavernous sinus [3], dural fistula [4], carotid artery dissection [5][6][7][8], arteriovenous malformation [9] and subclavian steal syndrome [10].…”

Spontaneous intrapetrous internal carotid artery dissection: A case report and literature review

“…Search keywords were "spontaneous", "dissection" or "dissecting", "intrapetrous" or "petrous" and "internal carotid artery". Seven patients with spontaneous intrapetrous ICA dissection were identified in the English literature [2][3][4][5][6][7]. In total, 8 patients, including this patient, are reviewed in this report (Table 1).…”

“…Isolated ICA dissection involving the intrapetrous carotid canal is particularly rare; only 7 such patients have been reported in English literature since 1960 [2][3][4][5][6][7]. Although thromboembolism is supposed to be the main stroke mechanism in ICA dissection [8], hemodynamic change can also play an important role, especially in cases of intracranial dissection [1].…”

Cluster headache due to internal carotid artery dissection

“…Few patients have carotid imaging. In recent years, individuals with cluster headache secondary to ICAD have been described [10,11]. Identification of ICAD is important as it has substantial risk of stroke (55 %) with alternate management and prognosis [13].…”