Carotid artery dissection is a separation of the layers of the artery wall supplying oxygen-bearing blood to the head and brain and is the most common cause of stroke in young adults. (Dissection is a blister-like de-lamination between the outer and inner walls of a blood vessel, generally originating with a partial leak in the inner lining. )Dissection may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation, but may also happen spontaneously. Signs and symptoms
The signs and symptoms of carotid artery dissection may be divided into ischemic and non-ischemic categories:Non-ischemic signs and symptoms:

Localised headache, particularly around one of the eyes
Neck pain
Swollen tongue
Decreased pupil size with drooping of the upper eyelid (Horner syndrome)
Pulsatile tinnitusIschemic signs and symptoms:

Temporary vision loss
Ischemic stroke

Causes
The causes of internal carotid artery dissection can be broadly categorized into two classes: spontaneous or traumatic.
However, when blood clots form and break off from the site of the tear, they form emboli, which can travel through the arteries to the brain and block the blood supply to the brain, resulting in an ischaemic stroke, otherwise known as a cerebral infarction. Blood clots, or emboli, originating from the dissection are thought to be the cause of infarction in the majority of cases of stroke in the presence of carotid artery dissection. Cerebral infarction causes irreversible damage to the brain. In one study of patients with carotid artery dissection, 60% had infarcts documented on neuroimaging. Treatment
The goal of treatment is to prevent the development or continuation of neurologic deficits. Treatments include observation, anti-platelet agents, anticoagulation, stent implantation, carotid endarterectomy, and carotid artery ligation. Epidemiology
70% of patients with carotid arterial dissection are between the ages of 35 and 50, with a mean age of 47 years. See also
Aortic dissection
Vertebral artery dissection

References


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