The ophthalmology of internal carotid artery dissection

Abstract

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.

Intercavernous portion of internal carotid artery occlusion resulting from snowboarding

“…Oculosympathetic paresis is the third most common clinical presentation in patients with spontaneous dissection which may occur minutes to days after the onset of headache 7. It includes incomplete Horner’s syndrome where facial sweating is unaffected.…”

Severe acute ocular ischemia associated with spontaneous internal carotid artery dissection

“…Generally, ophthalmic symptoms usually occur in combination with other systemic signs, e.g., pulsatile tinnitus, cranial nerve palsy, head, facial, and neck pain. Thus, these changes indicate that the ocular symptoms should not be overlooked as a first indication of an ICA dissection [1,5,6]. …”

Unilaterale Amaurose als einziges fokales Zeichen einer Carotis-communis-Dissektion

“…Die Dissektion eines hirnversorgenden Halsgefäßes stellt insbesondere bei Patienten im Alter unter 50 Jahren eine wichtige Ursache zerebraler und retinaler Ischämien dar [5,6,11]. So kann eine Dissektion der am häufigsten betroffenen A. carotis interna nicht nur zu ausgedehnten hemisphäriellen Ischämien mit ausgeprägten neurologischen Ausfällen, sondern bei mehr als der Hälfte der Betroffenen auch zu verschiedenen okulären Krankheitszeichen führen [3,9,22], wobei ophthalmologische Symptome zumeist eine gute Restitutionstendenz [8,14] und ein geringes Wiederholungsrisiko [5,11] aufweisen.…”

“…Zu den häufigsten okulären Symptomen gehört die Amaurosis fugax [2,10,11,16,20]. Bei bis zu 40 -50 % der Patienten tritt ein oft schmerzhaftes ipsilaterales Horner-Syndrom auf [3, 22 -24].…”