The Full Wiki

Carotid artery dissection: Wikis

Advertisements
  

Note: Many of our articles have direct quotes from sources you can cite, within the Wikipedia article! This article doesn't yet, but we're working on it! See more info or our list of citable articles.

Encyclopedia

From Wikipedia, the free encyclopedia

Carotid artery dissection
Classification and external resources
ICD-9 443.21
DiseasesDB 2145
eMedicine emerg/82

Carotid artery dissection is the most common cause of stroke in young adults.[1]

Contents

Signs and symptoms

The signs and symptoms of carotid artery dissection may be divided into ischaemic and non-ischaemic categories:[2]

Non-ischaemic signs and symptoms

  • Headache or neck pain


Ischaemic signs and symptoms

  • Decreased pupil size with drooping of the upper eyelid (Horner syndrome)
  • Transient vision loss
  • Ischemic stroke

Causes

The cause of internal carotid artery dissection can be broadly categorized into two classes: spontaneous or traumatic.

Advertisements

Spontaneous

Once considered uncommon, spontaneous carotid artery dissection is an increasingly recognized cause of stroke that preferentially affects the middle-aged.[3]

The incidence of spontaneous carotid artery dissection is low, and incidence rates for internal carotid artery dissection have been reported to be 2.6 to 2.9 per 100,000.[4]

Observational studies and case reports published since the early 1980s show that patients with spontaneous internal carotid artery dissection may also have hereditary connective tissue disorders and/or a history of stroke in their family. These include Marfan syndrome, vascular Ehlers-Danlos syndrome, autosomal dominant polycystic kidney disease, pseudoxanthoma elasticum, fibromuscular dysplasia, and osteogenesis imperfecta type I.[5]

However, the reports on the prevalence of hereditary connective tissue diseases in people with spontaneous dissections is highly variable, ranging from 0% to 0.6% in one study to 5% to 18% in another study. Nevertheless, although an association with connective tissue disorders does exist, most people with spontaneous arterial dissections do not have associated connective tissue disorders.[6]

Traumatic

Carotid artery dissection is more commonly thought to be caused by severe violent trauma to the head and/or neck. An estimated 0.67% of patients admitted to the hospital after major motor vehicle accidents were found to have blunt carotid injury, including intimal dissections, pseudoaneurysms, thromboses, or fistulas.[7] Of these, 76% had intimal dissections, pseudoaneurysms, or a combination of the two.

The probable mechanism of injury for most internal carotid injuries is rapid deceleration, with resultant hyperextension and rotation of the neck, which stretches the internal carotid artery over the upper cervical vertebrae, producing an intimal tear.[8] After such an injury, the patient may remain asymptomatic, have a hemispheric transient ischemic event, or suffer a stroke.[9]

Pathophysiology

Arterial dissection of the carotid arteries occurs when a small tear forms in the innermost lining of the arterial wall (known as the tunica intima). Blood can enter into the space between the inner and outer layers of the vessel, causing narrowing (stenosis) or complete occlusion. The stenosis that occurs in the early stages of arterial dissection is a dynamic process and some occlusions can return to stenosis very quickly.[10] When complete occlusion occurs, it may lead to ischemia. Often, even a complete occlusion is totally asymptomatic because bilateral circulation keeps the brain well perfused. 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 ischemic stroke, otherwise known as an 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.[10] Cerebral infarction causes irreversible damage to the brain. In one study of patients with carotid artery dissection, 60% had infarcts documented on neuroimaging.[11]

Treatment

The goal of treatment is to prevent the development or continuation of neurologic deficits. Treatments include observation,anticoagulation, stent implantation and carotid artery ligation.

Epidemiology

70% of the time it occurs in people between 20 and 40 years of age.[12]

See also

References

  1. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 46. ISBN 1-4051-4166-2.  
  2. ^ Kerry R, Taylor AJ. Cervical arterial dysfunction assessment and manual therapy. Manual Therapy 2006;11(4):243-53. PMID: 17074613
  3. ^ In: Neurology 2006;67:1809-1812. Mokri B. Spontaneous dissections of internal carotid arteries. Neurologist 1997;3:104–119.
  4. ^ VH Lee, et al. Incidence and outcome of cervical dissection; a population-based study. Neurology 2006;67:1809-1812.
  5. ^ JM de Bray, et al. History of spontaneous dissection of the cervical carotid artery. Arch Neurol. 2005;62:1168-1170.
  6. ^ JM de Bray, et al. History of spontaneous dissection of the cervical carotid artery. Arch Neurol. 2005;62:1168-1170.
  7. ^ TC Fabian, et al. Blunt Carotid Injury. Annals of Surgery. 1996; Vol. 223, No. 5: 513-52.
  8. ^ TC Fabian, et al. Blunt Carotid Injury. Annals of Surgery. 1996; Vol. 223, No. 5: 513-52.
  9. ^ JH Matsuura, et al. Traumatic Carotid Artery Dissection and Pseudoaneurysm Treated With Endovascular Coils and Stent Journal of Endovascular Surgery. 1997; Vol. 4, No. 4, pp. 339–343.
  10. ^ a b C Lucas, et al. Stroke patterns of internal carotid artery dissection in 40 patients. Stroke. 1998;29:2646-2648.
  11. ^ VH Lee, et al. Incidence and outcome of cervical dissection; a population-based study. Neurology 2006;67:1809-1812.
  12. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 46. ISBN 1-4051-4166-2.  

Advertisements






Got something to say? Make a comment.
Your name
Your email address
Message