Cervical artery dissection—an easily neglected cause of stroke: a case report

Abstract Background In recent years, the incidence of stroke has gradually increased in young people. There are many reasons causing stroke, including atherosclerosis, artery embolization, and cervical artery dissection and so on. However, cervical artery dissection is a major cause of stroke in young people. We present a case of ischemic stroke caused by dissection, whose distal vascular occlusion due to detachment of the thrombosis in the right internal carotid artery. Case presentation A 33-year-old male patient was admitted to the hospital because of stroke. Imaging examination showed that there was no visualization of the right middle cerebral artery and there were a large number of mural thrombus in the C1 segment of the right internal carotid artery. After emergency surgery, the patient had vascular recanalization and the symptoms were significantly improved. Magnetic resonance imaging showed a high signal in the C1 segment of the right internal carotid artery, the abnormal signal disappeared after antiplatelet therapy. Conclusions When a patient has symptoms of stroke, we need to explore the root cause of stroke. Especially in young people, cervical artery dissection is an important reason that can’t be ignored. Through review and analysis of this case, we hope to improve the understanding of radiologists and clinicians about the cervical artery dissection, reduce the rate of misdiagnosis, and improve patients’ prognosis.

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Internal carotid artery dissection in a patient with recent respiratory infection: case report of a possible link

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2005000300029 ◽

2005 ◽

Vol 63 (2b) ◽

pp. 523-526 ◽

Cited By ~ 4

Author(s):

Cynthia Resende Campos ◽

Thiago Gasperini Bassi ◽

Fabiano Pinto ◽

Demétrius Kasak P. Abrahão

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Respiratory Infection ◽

Internal Carotid ◽

Causal Link ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Internal Carotid Artery Dissection ◽

The Right

The pathogenesis of spontaneous cervical artery dissection remains unknown. Infection-mediated damage of the arterial wall may be an important triggering mechanism. We describe a 21 year-old man with respiratory infection (bronchial pneumonia) which was diagnosed and treated with antibiotic few days prior to the right internal carotid artery dissection. The patient presented ischemic retinal and cerebral strokes. Based on literature review, we discuss the possibility of a causal link between infection and arterial dissection.

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Treatment of Middle Cerebral Artery Occlusion and Internal Carotid Artery Dissection with Combined Mechanical Thrombectomy and Stenting of the Internal Carotid Artery

The Neuroradiology Journal ◽

10.1177/197140091302600114 ◽

2013 ◽

Vol 26 (1) ◽

pp. 84-88 ◽

Cited By ~ 2

Author(s):

A. Wetter ◽

Mi-Rim Shin ◽

D. Meila ◽

F. Brassel ◽

M. Schlunz-Hendann

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Artery Dissection ◽

Severe Stroke ◽

The Right

We describe a case of combined mechanical thrombectomy of the right middle cerebral artery and stent angioplasty of the right internal carotid artery in a severe stroke caused by arterio-arterial embolism due to a traumatic dissection of the internal carotid artery. The patient was admitted with an NIHSS score of 19 and was discharged from hospital with a score of 2. Three months later neurological examination disclosed no pathological findings. The case demonstrates the crucial role of interventional procedures in the treatment of severe stroke where intravenous thrombolysis has little prospect of success.

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Emergent Endovascular Treatment of a Spontaneous Internal Carotid Artery Dissection with Pseudoaneurysm

Journal of Endovascular Therapy ◽

10.1177/152660280301000334 ◽

2003 ◽

Vol 10 (3) ◽

pp. 643-646 ◽

Cited By ~ 6

Author(s):

Albert Tseng ◽

Venkatesh Ramaiah ◽

Julio A. Rodriguez-Lopez ◽

Paul E. Perkowshi ◽

Peter B. Del Santo ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Endovascular Treatment ◽

Internal Carotid ◽

Common Femoral Artery ◽

Carotid Artery Dissection ◽

Coronary Stent ◽

Artery Dissection ◽

Pseudoaneurysm Formation ◽

The Right

Purpose: To report the use of a coronary stent-graft for the endovascular treatment of a spontaneous internal carotid artery (ICA) dissection complicated by a large pseudoaneurysm. Case Report: A 68-year-old man presented to an outside hospital with complaints of headache, severe left-sided neck pain, fever, chills, and vomiting. Contrast-enhanced computed tomography revealed a large (3.5×3 cm) extracranial aneurysm of the left ICA. The patient was emergently transferred to our facility for endovascular treatment of the carotid aneurysm. Via a percutaneous access in the right common femoral artery, 2 Jostent coronary stent-grafts were deployed across the aneurysm with no evidence of a residual pseudoaneurysm. The patient was hemodynamically stable throughout the procedure. Duplex examination at 9 months revealed no evidence of a residual pseudoaneurysm, dissection, or endoleak. Conclusions: Covered coronary stents may have a role in the treatment of spontaneous ICA dissection with pseudoaneurysm formation.

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BILATERAL INTERNAL CAROTID ARTERY DISSECTION WITH CONFUSION

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2015-312379.167 ◽

2015 ◽

Vol 86 (11) ◽

pp. e4.76-e4

Author(s):

Ambika Kapoor ◽

Krishna Chinthapalli ◽

Graham Warner

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Brain Magnetic Resonance Imaging ◽

Cerebral Hypoperfusion ◽

Horner’S Syndrome ◽

Artery Dissection ◽

Horner's Syndrome ◽

Cognitive Changes ◽

The Right

Bilateral internal carotid artery (ICA) dissections are rare. Typical clinical presentation includes cerebral ischaemia, neck/headache, Horner's syndrome & pulsatile tinnitus1.We present a forty-two year old right-handed man admitted to hospital with a ten day gradual onset headache, altered taste, widespread cognitive impairments, horizontal diplopia and a right Horner's syndrome. There was no history of trauma. Brain magnetic resonance imaging revealed multiple small embolic infarcts in carotid territories of both cerebral hemispheres. Computed tomography angiogram (CTA) of intracranial and extracranial vessels revealed occlusion of the left ICA and attenuation of the right ICA below the skull base.Symptoms resolved within 3–5 days of starting sub-cutaneous low molecular weight heparin and he was then anticoagulated with warfarin for six months. Repeat CTA at 4 months showed persisting complete left ICA occlusion but complete recanalisation of the right ICA.This is the first description of cognitive changes following bilateral ICA artery dissections. Whilst ICA dissection presentations are usually explained by embolic phenomena or local effects upon ICA walls, the mechanism here is probably due to cerebral hypoperfusion. Cognitive assessment should be performed in all patients presenting with ICA dissection especially when it is bilateral.

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Cough-Induced Extracranial Internal Carotid Artery Dissection

Case Reports in Neurology ◽

10.1159/000501069 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 149-155

Author(s):

Mei-Ling Sharon Tai ◽

Sheau Fung Sia ◽

Khairul Azmi Abdul Kadir ◽

Mohamad Imran Idris ◽

Kay Sin Tan

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Respiratory Tract ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

High Signal ◽

Upper Respiratory Tract ◽

Magnetic Resonance Imaging Mri ◽

Tract Infections

Background: Coughing due to respiratory tract infections may lead to internal carotid artery (ICA) dissection. Aim: We are presenting a patient with an unusual cough-induced ICA dissection. Case Report: A 42-year-old health care worker presented with bilateral hand numbness which resolved spontaneously. This initial episode was followed 9 days later with intermittent episodes of right hand and leg weakness with speech difficulty. Two days later, he had another episode of speech difficulty. One week prior to the first presentation, he had upper respiratory tract infection with ongoing strong bouts of coughing. Magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) of the brain showed early ischaemic changes at the left frontal and left parietal regions. MR angiography (MRA) showed high signal intensity at the left proximal ICA and poor flow beyond the left carotid bulb. Cerebral angiography revealed left ICA dissection. Conclusion: Proper identification of cough-induced extracranial ICA dissection is important because this is treatable.

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Spontaneous Cervical Artery Dissection: A Case Series

10.1101/2020.08.25.20181933 ◽

2020 ◽

Author(s):

Amedra Basgaran ◽

Catherine Hsu ◽

Aravinth Sivagnanaratnam

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Case Series ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Cervical Artery ◽

Incomplete Healing

Cervical artery dissection refers to dissection of the vertebral or carotid arteries, and accounts for up to 20% of strokes in those under 45. Antithrombotic therapy is therefore essential to limit thrombosis at the site of injury and distal neuronal damage. However, the exact choice of drugs, timing and duration of therapy remain a challenging decision. A review of data was conducted on three cases of unprovoked cervical dissection at our stroke center between 2017 and 2020. They include bilateral internal carotid artery dissection, right vertebral artery dissection, and left internal carotid artery dissection. Three key outcomes were identified: narrowing, occlusion and pseudoaneurysm; such outcomes dictated our management approach. Two patients were given antiplatelet therapy for at least one year. The patient with bilateral dissection was perceived to have higher thromboembolic risk, due to the presence of a free-floating thrombus. Thus, he was anticoagulated for a year, and thereafter given antiplatelet therapy. The evidence behind long-term management of carotid artery dissection remains equivocal. There is no strong evidence favouring anticoagulation over antiplatelets or vice versa. Anticoagulation tends to be preferred in cases of severe stenosis, occlusion or pseudoaneurysm, to reduce the risk of thromboembolic phenomena. Anti-platelets are preferred where there is a high risk of haemorrhagic transformation or contraindication to anticoagulation. The duration of secondary prevention is similarly unclear. Advances in radiology and increased follow-up have resulted in uncertainty on the management of incomplete healing at the six-month point. Varying clinical practice has been identified and there is a lack of a clear guideline. We propose continuing antithrombotic therapy in cases of incomplete healing, as in our case series. Nevertheless, we require more data on the subject and thus suggest an initial nation-wide survey to compare the different management strategies followed by large-scale retrospective analyses comparing long-term outcomes.

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Spontaneous bilateral internal carotid and vertebral artery dissections with dominant-hemisphere circulation maintained by external carotid artery–ophthalmic artery anastomoses

Neurosurgical FOCUS ◽

10.3171/2018.11.focus18443 ◽

2019 ◽

Vol 46 (2) ◽

pp. E6 ◽

Cited By ~ 2

Author(s):

Danielle Golub ◽

Lizbeth Hu ◽

Siddhant Dogra ◽

Jose Torres ◽

Maksim Shapiro

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Ophthalmic Artery ◽

Internal Carotid ◽

External Carotid Artery ◽

External Carotid ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Extracellular Matrix Components

Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. The authors present the case of a 49-year-old, otherwise healthy woman, who over the course of 2 weeks developed progressive, hemodynamically significant, bilateral internal carotid artery and vertebral artery dissections. Collateral response involved extensive external carotid artery–internal carotid artery anastomoses via the ophthalmic artery, which were instrumental in maintaining perfusion because circle of Willis and leptomeningeal anastomotic responses were hampered by the dissection burden in the corresponding collateral vessels. Endovascular intervention by placement of Pipeline embolization devices and Atlas stents in bilateral internal carotid arteries was successfully performed. No syndromic or systemic etiology was discovered during a thorough workup.

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Internal Carotid Artery Dissection during Puerperium: A Case Report

10.5327/1516-3180.456 ◽

2021 ◽

Author(s):

Leonardo de Sousa Bernardes ◽

Raphael Palomo Barreira ◽

Marina Trombin Marques ◽

Danyelle Sadala Reges ◽

Vivian Dias Baptista Gagliardi ◽

...

Keyword(s):

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Neck Pain ◽

Cerebral Artery ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

The Right

Background: Carotid or vertebral artery dissection is a rare puerperium event, occurring in less than 6% of cases. Although physiopathology is not completely understood, it is probably multifactorial involving increased cardiac output, hypervolemia and hormonal changes remodeling endothelium and favoring dissection. Most patients present headache and neck pain, but it is also reported Horner syndrome, tinnitus, retroorbital pain and cranial nerve palsies. Case Report: Female, 39-year-old patient in the 20th day of puerperium presents a sudden headache with transitory left hemiparesis and dysarthria for 30 minutes. Magnetic Resonance Imaging (MRI) with angioresonance revealed an area of right middle cerebral artery (MCA) infarction and right internal carotid artery dissection in the cervical segment with a large intraluminal thrombus. The diagnosis was stablished as ischemic stroke caused by carotid dissection. Transcranial doppler presented post stenotic flow in the right MCA, flow inversion in the right anterior cerebral artery (ACA) and ipsilateral collateral circulation of the external carotid artery. After two months on double antiplatelet treatment (apirin 100mg and clopidogrel 75mg), it was partially recanalized and there was improvement in the collateral and hemodynamic pattern. Conclusion: Puerperium pacients describing intense headache or neck pain should be investigated with MRI and angioresonance of intracranial and cervical vessels. In the cervical arterial dissection it is recommended double antiplatelet therapy, for three to six months.

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Navien catheter experience in neuroendovascular interventions

Interventional Neuroradiology ◽

10.1177/1591019917717575 ◽

2017 ◽

Vol 23 (5) ◽

pp. 551-555 ◽

Cited By ~ 3

Author(s):

Gaurav Jindal ◽

Luciano Giacon ◽

Moronke Iyoha ◽

Timothy Miller ◽

Francois Aldrich ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Internal Carotid ◽

External Carotid ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Catheter Position ◽

Guide Catheter ◽

Cervical Internal Carotid Artery

Purpose Advancements in catheter technology have allowed for greater flexibility and trackability. We report 265 consecutive, single-center neurointerventional cases using the Navien guide catheter. Materials and methods Retrospective analysis was performed of consecutive intracranial endovascular procedures utilizing the Navien catheter. Data collected included procedure type, catheters, guide catheter position, cervical access artery tortuosity grade and complications. Results The 5 French catheter was used in 130 cases. The 6 French catheter was used in 135 cases. Access was via the internal carotid artery in 204, external carotid artery in 10, and vertebral artery in 51 cases. Catheter tip position was in the petrous segment of the internal carotid artery in 36.6% (97/265), distal cervical internal carotid artery in 13.9% (37/265), cavernous internal carotid artery in 10.2% (27/265), proximal or mid cervical internal carotid artery in 5.6% (15/265), supraclinoid internal carotid artery in 0.8% (2/265), and intradural vertebral artery in 0.8% (2/265) of cases. Catheter position was not determined in 18.9% (50/265) of cases. Proximal vessel tortuosity (grade B or C) was present in 98 cases (37%), and the catheter was tracked distal to the tortuosity in 93% (91/98) of these cases. The overall success rate without catheter complication was 97% (258/265). The Navien was replaced by another catheter in 1.9% (5/265) of cases. There was one cervical artery dissection (0.4%) and one severe vasospasm (0.4%) necessitating Navien removal. Conclusions The Navien guide catheter provided distal access support for neuroendovascular interventions in nearly all cases, including cases with proximal artery tortuosity, with a low rate of catheter-related complications.

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Internal Carotid Artery Dissection and Ischemic Cerebral Infarction in the Setting of Essential Thrombocythemia

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029610391651 ◽

2010 ◽

Vol 17 (6) ◽

pp. E138-E140 ◽

Cited By ~ 5

Author(s):

T. Freilinger ◽

T. Saam ◽

M. Duering ◽

M. Dichgans ◽

N. Peters

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Essential Thrombocythemia ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Stroke In Young Adults ◽

Spontaneous Dissection ◽

Stroke In Young

Cervical artery dissection (CAD) is an important etiology of stroke in young adults. Its etiology is incompletely understood. Here, we report a young woman who presented with acute ischemic stroke in the setting of internal carotid artery (ICA) dissection and essential thrombocythemia (ET). We present a review of previous cases with comorbidity of CAD and ET and discuss the pathophysiological implications of this co-occurrence. In particular, we speculate that ET may increase the susceptibility of cervical vessels to spontaneous dissection, for example, by disturbing the microcirculation within the vessel wall.

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