Spontaneous internal carotid artery dissection

Once considered uncommon, spontaneous dissection of the carotid artery is an increasingly recognized cause of stroke, headache, cranial nerve palsy, or ophthalmologic events, especially in young adults. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced physicians of all specialties. We report a case of spontaneous internal carotid artery dissection in a 38-year-old woman with a cortical stroke and visual disturbances as initial symptoms. The diagnosis was confirmed by magnetic resonance imaging/angiography and by angiography. Prompt anticoagulation was instituted, and the patient had complete resolution of symptoms. Cervicocephalic arterial dissection should be included in the differential diagnosis of the causes of cerebrovascular events.     

Spontaneous carotid artery dissection with cluster-like headache

A case of carotid artery dissection in a 41-year-old-woman is described whose main symptom was cluster-like pain. The case is interesting for its atypical presentation with only two other like cases in the literature, and the site of dissection, localized in the intrapetrous curvature of the carotid artery. The case highlights the need for active co-operation between clinician and neuroradiologist during neuroimaging assessment which must be focused on the clinical evaluation of the individual patient so as to avoid error, particularly in atypical cases.     

Spontaneous internal carotid artery dissection shown by magnetic resonance imaging

We have reported a case of spontaneous dissection of the internal carotid artery, with MRI and angiographic findings. We conclude that MRI is a beneficial noninvasive test for the detection and study of carotid artery dissection.     

Spontaneous carotid artery dissection presenting as migraine--a diagnosis not to be missed.

Two cases are reported in which the diagnosis of a serious condition was delayed as the symptoms had been attributed to migraine. Spontaneous carotid artery dissection is a serious but treatable cause of headache that may be misdiagnosed as recent onset migraine. The importance of correctly identifying this condition is emphasised.     

Spontaneous celiac artery dissection

BackgroundSpontaneous celiac artery dissection is a rare visceral artery dissection that typically presents with acute abdominal or flank pain.Case reportWe describe a case of a 54-year old previously healthy male who presented to the Emergency Department with subacute back pain and was found to have a spontaneous celiac artery dissection.Why should an emergency physician be aware of this?Emergency medicine physicians frequently consider acute aortic dissection in patients presenting to the Emergency Department with acute chest, back, and/or upper abdominal pain. Less commonly thought of are variations of arterial dissection, including those involving the celiac artery. Given readily available diagnostic imaging modalities and therapeutic interventions, it remains important to consider visceral arterial dissection, and to recognize the varied clinical manifestations of this rare clinical entity.     

Spontaneous coronary artery dissection

A 45-year-old female athlete with no history of cardiovascular disease or coronary risk factors presented with a non-ST-segment elevation myocardial infarction due to spontaneous right coronary artery dissection. She was treated medically with resolution of her symptoms. Repeat angiography due to recurrent exertional chest discomfort showed TIMI-3 flow and no evidence of dissection. Intravascular ultrasound documented discrete areas of resolving hematoma, but no dissection flap or impingement of the lumen >30%. A coronary computed tomography 6 months later revealed absence of any vascular abnormalities. This rare but potentially lethal condition should be considered in the differential diagnosis of young patients with chest pain, myocardial infarction, or sudden cardiac death, especially if it involves women either in the peripartum period or those using oral contraceptives, or patients without evidence of coronary atherosclerosis or traditional cardiovascular risk factors.     

Spontaneous coronary artery dissection

Spontaneous coronary artery dissection is a rare cause of myocardial ischaemia or sudden death, predominantly affecting young women with no known risk factors for cardiovascular disease. The case described emphasises the benefit of early diagnosis and the need to individualise management based on patient response to treatment.     

Spontaneous post-partum cervical carotid artery dissection in a patient with reversible cerebral vasoconstriction syndrome

Post-partum cervicocephalic artery dissection (pp-CAD) is a rare and poorly understood condition. To our knowledge, only 21 cases have been reported. Reversible cerebral segmental vasoconstriction (RCSV) was first described by Call and Fleming in 1988, and its association with pp-CAD has only been reported in three cases. However, in those cases it is unclear whether the pp-CAD may have been caused by straining during labor and therefore merely coincidental to the intracranial arteriopathy. We describe a 41-year-old right-handed African-American woman who developed the syndrome of pp-CAD (headaches, trace subarachnoid hemorrhage and diffuse cerebral arteriopathy on angiogram) two weeks after delivery. In this unique case, the patient had fortuitously undergone an MR study twice over a four day period which included the carotid bifurcations. During that time the patient was an inpatient, on bed rest and subject to continuous cardiac monitoring. The interval studies documented a true spontaneous right internal carotid artery dissection occurring without obvious cause. The patient had noted moderate right neck pain developing between the two MR studies but experienced no neurological deficits. Subsequent conventional angiography confirmed the presence of postpartum cerebral arteriopathy and the cervical dissection. The patient was managed conservatively with antiplatelet medication and had an otherwise uneventful course. We hypothesize whether transient arterial wall abnormalities, postpartum hormonal changes or subtle connective tissue aberrations play a similar role in the pathogenesis of these two associated conditions.     

Spontaneous isolated inferior mesenteric artery dissection

This report presents a case of a spontaneous isolated inferior mesenteric artery (IMA) dissection. To the best of our knowledge, it is the first report in the literature. A fifty-eight-year-old female who suffered from acute left lower abdominal pain was admitted. CT scan and digital subtraction angiography indicated dilation in the proximal part of the IMA and occlusion in its distal part. Signs of peri-artery exudation also seen in the CT scan. Laparotomy confirmed the diagnosis of IMA dissection and secondary thrombosis in its branches. After thrombectomy and intimal flap resection, the artery was successfully reconstructed with an autogenous vein patch. Isolated IMA dissection should be considered as one of the differentiation for patients with acute abdomen. Dilation, occlusion of the artery, and signs of peri-artery edema were important clues to suspect the IMA dissection. High resolution spiral CT, which may sometimes reveal the signs such as double lumen and intimal flap, helped to establish the diagnosis of such lesion.     

Spontaneous dissection of the hepatic artery

Two cases of spontaneous dissection of hepatic arteries are described. Presentation and management of these two patients are distinctly different. The first patient presented with mild back pain and mild abnormal liver function tests and was treated conservatively. The second patient presented with hemoperitoneum and shock and was treated surgically.     

超声影像在颈动脉夹层诊断中的特征分析

目的本研究目的分析颈动脉夹层的超声表现,总结颈动脉夹层超声特征。方法选择2007年1月~2014年12月北京天坛医院经MRA(n=10)和/或DSA(n=10)证实的颈动脉夹层患者共计20例,男17例,女3例,年龄25~68岁(中位年龄46岁),结合MRA或DSA分析颈动脉夹层在超声影像中的图像特征。结果 20例颈动脉夹层患者其中颈总动脉夹层5例,颈内动脉夹层15例。超声能够明确诊断颈动脉夹层患者12例,表现为典型"双腔管"征(真腔和假腔),检出率60%;超声诊断颈动脉夹层总符合率75%,漏诊率25%。Youden指数为75%。结论超声诊断颈动脉夹层与DSA/MRA相比具有较高符合率,可以作为评价颈动脉夹层的首选无创性筛查手段,最终诊断依赖于DSA/MRA。     

Cerebral microembolism and extracranial internal carotid artery dissection.

Although extracranial ICA dissection is recognized as a cause of cerebral infarction, 1-3 the pathogenesis of ischemic symptoms in an individual patient with the condition is not always understood, making treatment decisions difficult. We describe a patient with traumatic cervical ICA dissection diagnosed on the basis of noninvasive tests, in whom TCD ultrasonography was used to detect ipsilateral distal microembolization associated with clinical deterioration.     

Traumatic carotid artery dissection causing blindness

A case of delayed postoperative visual loss due to bilateral traumatic carotid artery dissection is presented. In patients with a major craniofacial injury due to a high-speed motor vehicle accident, we suggest that carotid artery duplex ultrasonography be used in the initial evaluation for possible carotid artery dissection. Magnetic resonance imaging of the head and neck with magnetic resonance angiography should be performed subsequently if indicated. Early diagnosis and initiation of therapy can minimize complications.