Type:
Educational Exhibit
Keywords:
Dissection, Acute, Diagnostic procedure, Computer Applications-Detection, diagnosis, MR-Angiography, CT-Angiography, Catheter arteriography, Vascular, Neuroradiology brain, Head and neck
Authors:
J. Blay Beltran1, L. Navarro Vilar2, C. Poyatos1, C. Fonfria1, M. Atares 1, L. Requeni1, R. Revert Espí1, D. Gomez3; 1Valencia/ES, 2Valencia, Va/ES, 3CO
DOI:
10.1594/ecr2013/C-2376
Background
The carotid dissection consists in a leakage of blood to the middle layer through an intimal flap of the arterial wall or,
alternatively,
media haemorrhage from vasa vasorum.
Blood usually enters the media at the site of intimal injury,
and the dissection usually extends cranially in the same direction as the bloodstream.
The intramural hematoma usually compresses the true lumen of the artery and causes enlargement of the external diameter of the artery.
The aetiology can be traumatic (blunt or penetrating injury) or spontaneous such as in bad postures or cervical manipulation.
The latter can be accompanied by an underlying arterial disease: fibromuscular displasia,
Ehler-Danlos syndrome type IV,
Marfan's syndrome,
autosomal dominant adult polycystic kidney disease,
cystic medial necrosis and osteogenesis imperfecta type I.
There are some vascular risk factors also associated with carotid dissection such as hypertension,
diabetes mellitus,
smoking and hyperlipidemia.
Carotid dissection can occur at any age but is a common cause of ischemic stroke in up to 25% of patients younger than 45 years,
making it an important disease with high potential for morbidity in people with high life expectancy.
The classical presentation of extracranial ICA dissection is ipsilateral headache,
facial or neck pain and partial Horner's syndrome with late amaurosis fugax.
This presentation is only present in less than one third of patients.
Strokes are reported in 40-60% and transient ischemic attack (TIA) in 20-30% of patients with ICA dissection.
In most cases,
the clinical presentation can be non-specific so in this cases imaging studies acquire a great diagnostic importance.