![]() The presence of blunt or penetrating trauma is helpful to make the diagnosis. The family history of carotid dissection or connective tissue disorders may heighten one's suspicion. When stroke-like symptoms are present with these symptoms, it can make the diagnosis somewhat less difficult. A Horner syndrome may be present if a hematoma of the cervical artery compresses the adjacent sympathetic nerve fibers. The pain when present is usually on the ipsilateral side. Classic teaching describes a headache, facial or eye pain, and neck pain. The presentation can range from an asymptomatic patient to one who presents with an acute stroke. There is a tremendous amount of variation in the presentation of carotid dissection, hence making the diagnosis a challenge. Also, a pseudoaneurysm may result from a carotid dissection. If the vessel ruptures intracranially, it may lead to a subarachnoid hemorrhage. It may also be a nidus for thrombus formation that may later migrate distally, causing a stroke or transient ischemic attack. This process may lead to a stroke from a complete vascular occlusion at the site of the dissection. This depends on where the hematoma develops, either toward the intima or adventitia. This is a dynamic process that may lead to stenosis of the vessel or dilatation of the artery. As blood enters this false lumen, it causes stenosis which may lead to complete occlusion of the carotid artery. This tear allows blood to flow into this intimal layer of the vessel and allows a hematoma to form within the blood vessel wall. These may be due to trauma or they can be spontaneous. Ī sudden tear in the intimal layer of the carotid artery occurs due to the factors listed above. An elongated styloid process, which is called Eagle Syndrome, can also cause a spontaneous internal carotid artery dissection. ![]() Marfan syndrome, Ehlers-Danlos syndrome, fibromuscular dysplasia and other connective tissue disorders also increase the risk of this disease. "Idiopathic" is the most common cause of spontaneous carotid dissections in which a family history of dissection significantly increases one's risk. A motor vehicle accident where there is rapid deceleration with simultaneous neck hyperextension and rotation may lead to an intimal tear of the carotid artery. Blunt trauma can be significant (e.g., motor vehicle collision), or it can seem minimal (e.g., chiropractic manipulation being the most classic example). Traumatic dissection can either be by blunt or penetrating trauma. The intramural hematoma causes stenosis and eventual thrombus formation. This tear can be spontaneous or caused by trauma. ![]() Carotid artery dissection occurs spontaneously when a tear occurs in the intimal layer of the carotid artery creating an intramural hematoma.
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