CASE 4085 Published on 13.12.2005

Carotid artery dissection

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Pallladas P., Voultsinou D., kalpakidis. Department of Radiology. General Regional Hospital «G Papanikolaou», Thessaloniki /Greece

Patient

37 years, female

Clinical History
A 37 years –old women was referred to the hospital after a syncope episode. A left hemiparesis syndrome developed later. Brain CT scan, brain MRI, MRI angiography, colar Doppler and subtraction angiography were performed
Imaging Findings
CT features were in favor of ischemic brain infarct. The MRA, color Doppler findings were compatible with dissection of the right subclavian artery. Digital substraction angiography showed complete obstruction of the right internal carotid and complete recanalization after stent placement. The diagnosis of dissection of the right internal carotid and subsequent ischemic infarct was made. Improvement of hemiplegia observed after the stent placement
Discussion
Carotid dissection occurs as an intimal rupture allows blood to enter the arterial wall. The wall hematoma compresses the arterial lumen and restricts the arterial flow in it. Most frequent carotid dissection located in the proximal common carotid 1-2 cm from the carotid division to the vessel entering the temporal bone. Less commonly is located in the cranial base. Typically occurs after a major trauma but it also develops after a minor trauma or spontaneously. Predisposing factors for arterial dissection are hypertension, fibromuscular dysplasia, Marfan syndrome, Ehlers-Danlos type IV syndrome, cystic medial necrosis, oral contraceptives, drugs (sympathicomimetic) and infection. It is important to realize the early sings of carotid dissection and initiate proper therapy in order to restrict complications. Dissection more commonly occurs in the third to fifth decade but any age can be involved. It is responsible for the 5% of the brain infarct in the adults. The infarct is a result of thrombus and embolic material develop in the stenosed lumen fact that can be prevented with appropriate treatment. The imaging findings of brain infarct in case of carotid dissection are the same to those of another etiology. Carotid dissection can be undiagnosed if there is no history of trauma. The management includes anticoagulant therapy in absence of brain hemorrhage or extensive brain infarct. In unresponsive cases inervention is instituted in combination with anticoaqulant therapy.
Differential Diagnosis List
carotid artery dissection
Final Diagnosis
carotid artery dissection
Case information
URL: https://www.eurorad.org/case/4085
DOI: 10.1594/EURORAD/CASE.4085
ISSN: 1563-4086