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CAROTID ARTERY DISSECTION

Paddy Kalish OD Blog CAROTID ARTERY DISSECTION

 

Carotid artery dissection is a tear in the inner layer of the carotid artery wall that allows blood to flow between the layers. It can be caused by injury or occur suddenly without a known cause. https://people.com/mom-died-flight-from-dominican-republic-experienced-medical-tragedy-brother-says-8609170

Carotid artery dissection is the most common cause of stroke.

Symptoms:
  • Headache.
  • Scalp pain.
  • Eye pain.
  • Neck pain.
  • One eye with a droopy lid and small pupil (partial Horner syndrome)
  • One-sided weakness or numbness.
  • Pulsing sound in an ear.
  • Trouble swallowing.

      CAUSES:

An injury to the neck can cause carotid dissection. The injury may be caused by something like a car accident.

Some people with diseases that are known to weaken arterial walls are at greater risk for a dissection. These dissections can occur with vigorous physical activity such as:

  • Swimming and scuba diving
  • Skating and dancing
  • Play sports such as tennis, basketball, or volleyball
  • Doing yoga
  • Riding roller coasters or other rides
  • Jumping on a trampoline
  • Giving birth
  • Having sex
  • Sneezing or coughing
  • Receiving extreme neck manipulations

 A carotid dissection can also occur suddenly, without a known cause.

RISK factors:

  • Infection
  • High blood pressure
  • Migraine headaches
  • Smoking
  • An elongated styloid process
  • Use of birth control pills
  • Alcohol use
  • Fibromuscular dysplasia
  • Ehlers-Danlos syndrome
  • Marfan syndrome
  • Homocystinuria
  • Alpha-1 antitrypsin deficiency
  • Osteogenesis imperfecta
  • Cystic medial necrosis of the aorta
  • Segmental mediolytic arteriopathy
  • Reticular fiber deficiency
  • Reversible cerebral vasoconstriction syndrome
  • Autosomal dominant polycystic kidney disease

TESTING:

  • Lumbar puncture with analysis of cerebrospinal fluid
  • Magnetic resonance imaging (MRI) of the brain and neck
  • Magnetic resonance angiography (MRA) of the brain and neck
  • Cranial computed tomography (CT)
  • Cranial computed tomography angiography (CTA)
  • Carotid doppler and ultrasound

TREATMENT:

  • Clot-busters (thrombolytics), if your dissection caused a stroke
  • Heparin to prevent more blood clots
  • Intravenous (IV) fluids
  • Blood pressure medicine
  • Insulin or glucose to control your blood sugars
  • Pain medicines, such as acetaminophen, ibuprofen, or naproxen
  • Antiplatelet medicines, such as aspirin
  • Anticoagulant therapy with warfarin or other anticoagulation drugs
  • Surgery/Stent(s)

A carotid dissection can cause problems with blood flow to Brain or Eyes. This can cause a TIA, stroke, or one-sided blindness, which are Medical Emergencies. Call 911 if one be having a stroke or TIA or if there is sudden loss of vision.

https://www.youtube.com/watch?v=RfbkqTfGwHs

 

B.E. F.A.S.T. stands for: 

  • B is for balance. Sudden loss of balance or coordination.

  • E is for eyes. Vision changes in one or both eyes.

  • F is for face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

  • A is for arm weakness. One arm is weak or numb. When the person lifts both arms and the same time, one arm may drift downward.

  • S is for speech difficulty. You may notice slurred speech or trouble speaking. The person can't repeat a simple sentence correctly when asked.

  • T is for time to call 911. If someone exhibits any of these symptoms, even if they go away, call 911 right away. Make note of the time the symptoms first appeared.

 

Author
Paddy Kalish OD, JD and B.Arch

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