Stroke secondary to carotid dissection

Definition

A stroke secondary to carotid dissection is a type of stroke due to a tear in the lining of a major neck artery, called the carotid artery.

Causes

A stroke is an interruption of the blood supply to any part of the brain. When a tear in the lining of the carotid artery occurs (carotid dissection), blood flows in between layers of the blood vessel. This causes narrowing of the vessel, which makes it hard for blood to travel properly.

Stroke secondary to carotid dissection, unlike many other forms of stroke, may occur in young people, usually under 40 years old. Dissection accounts for less than 5% of strokes.

The risks for stroke secondary to carotid dissection include a history of disorders that cause weakness of the blood vessels, such as Marfan syndrome and fibromuscular dysplasia. Injury to the neck and certain medical procedures involving the carotid artery (such as an arteriogram) also raises your risk.

Symptoms

• Pain in the neck, which may travel to the eye
• Pulsing in the ears (pulsatile tinnitus)
• Weakness or total inability to move a body part
• Numbness, loss of sensation, or tingling
• Horner's syndrome
  • Eyelid drooping (ptosis)
  • Abnormal pupils
  • Abnormal facial sweating
• Trouble seeing, may occur in one or both eyes
• Problems talking or understanding speech
• Inability to recognize or identify sensory stimuli (agnosia)
• Loss of memory
• Vertigo (abnormal sensation of movement)
• Loss of coordination
• Swallowing difficulties
• Personality changes
• Mood and emotion changes
• Change in consciousness such as sleepiness, stupor, or lethargy
• Loss of consciousness
• Coma

Exams and Tests

A complete physical and neurological exam should be performed. This includes testing of all neurological functions, including vision, ability to feel sensations, movement, and mental function. The exam may reveal problems with vision, movement, sensation, reflexes, and speaking. The signs depend on how much blood flow is blocked at the time of the exam.

The doctor may hear an abnormal sound called a bruit when placing a stethoscope over the neck arteries. Blood pressure may be high. Some patients should signs of Horner's syndrome, such as drooping of one eyelid, lack of sweating on one side of the forehead, and a sunken appearance to one eye.

Tests may include:

• MRI or CT of the head
• Cerebral angiography
• MRA or a vascular ultrasound
• Blood tests to check for problems with connective tissue or certain genes

Treatment

Stroke is a serious condition. The sooner treatment is received, the better the person will do, and the lower the chance of permanent disability or death.

Treatment depends on the severity of symptoms.

Medicine may be needed to control high blood pressure. Blood thinning drugs, such as Coumadin or aspirin, may be needed for 3 to 6 months. Surgery to repair the carotid dissection may be required. Other therapies may be needed if there are any underlying disorders of the blood vessels.

For more information on treatment, see Stroke.

Outlook (Prognosis)

The outcome for stroke secondary to carotid dissection may be better than for stroke from many other causes, especially if the dissection is discovered and treated promptly.

When to Contact a Medical Professional

Stroke is a medical emergency. Immediately go to the emergency room or call the local emergency number (911 in the United States) if signs of a stroke occur.

Prevention

Care should be taken to protect the neck from injury, especially if you have any conditions that increase your risk for this type of stroke. Wearing seat belts while riding in a vehicle and helmets for various activities may somewhat reduce the risk for a stroke secondary to carotid dissection.

Aspirin therapy (81mg a day or 100mg every other day) is now recommended for stroke prevention in women under 65 as long as the benefits outweigh the risks. It should be considered for women over age 65 only if their blood pressure is controlled and the benefit is greater than the risk of gastrointestinal bleeding and brain hemorrhage

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.