Internal carotid artery dissection

The purpose of this review is to increase the awareness of internal carotid artery dissection (ICAD), a potentially serious and probably underdiagnosed condition. ICAD is a not uncommon cause of stroke in young patients. ICAD may occur spontaneously or as a result of trauma. However, the "spontaneous" dissection is often preceded by a trivial trauma. The typical patient presents with ipsilateral headache or neck pain, ipsilateral Horner's syndrome and delayed ischemic symptoms from the ipsilateral hemisphere or retina. Conventional angiography, the gold standard for diagnosis, tends to be replaced by non-invasive diagnostic methods. There are no evidence-based guidelines for therapy although anticoagulation is most commonly used. The references are selected from the Medline database for the years 1966-1997.     

Two symptomatic cases of cluster headache associated with internal carotid artery dissection

Neurological Sciences - Cluster headache is a clinical entity characterised by strictly unilateral head pain attacks accompanied by ipsilateral autonomic phenomena. We report two patients who had...     

Spontaneous internal carotid artery dissection presenting as hypoglossal nerve palsy

A 42-year-old man presented with right temporal headache, dysarthria, and dysphagia. On examination, he had a right hypoglossal nerve palsy. The diagnosis of right internal carotid artery dissection was suggested by magnetic resonance imaging and confirmed by carotid angiography. A dynamic computed tomogram demonstrated enlargement of the carotid artery. In carotid dissection, the hypoglossal nerve may be compromised by local factors as it passes close to the carotid artery in the neck.     

Left internal carotid artery dissection presenting with headache, Collet-Sicard syndrome and sustained hypertension

The baroreflex maintains blood pressure through the glossopharyngeal (IX) cranial nerve. We report a 54-year-old man who developed a left sided headache, hoarseness, dysarthria, dysphagia, and sustained hypertension from a left internal carotid artery dissection. We hypothesise that interruption of the left IX nerve caused hypertension in this patient.     

Internal carotid artery dissection after childbirth

A 44-year-old woman developed a left cerebral infarction secondary to internal carotid artery dissection 6 days after childbirth. A cesarean section had been carried out after 14 hours of strenuous unsuccessful labor. Although in the past some authors have implicated oral contraceptives as a cause for carotid dissection, carotid dissection associated with childbirth has not been previously described.     

Internal carotid artery dissection and stroke associated with wakeboarding

Wakeboarding is a popular water sport but has significant potential for trauma due to the high velocities, rotational maneuvers, acceleratory forces, water obstacles, and general lack of protective equipment used. Head or neck trauma is a concern, which may be even more common with wakeboarding than other water sports, but the true trauma incidence is unknown and probably underreported. While traumatic brain injury has been reported to occur during wakeboarding we present an unusual mechanism of central nervous system injury in which a young adult male developed a carotid artery dissection and stroke shortly following a wakeboarding accident.