From the Guidelines
Carotid dissection symptoms typically include sudden severe headache or neck pain, often on one side, followed by neurological symptoms like facial drooping, weakness or numbness on one side of the body, slurred speech, vision problems in one eye, or dizziness. These symptoms occur because the dissection—a tear in the artery wall—creates a false channel for blood flow, potentially forming clots that can block blood supply to the brain or directly reducing blood flow through the narrowed vessel 1. Symptoms may develop suddenly or gradually over hours to days. Some patients may hear a pulsating sound in their ear (pulsatile tinnitus) or develop Horner's syndrome (drooping eyelid, constricted pupil, and reduced sweating on one side of the face) 1.
Key Symptoms
- Sudden severe headache or neck pain, often on one side
- Neurological symptoms like facial drooping, weakness or numbness on one side of the body
- Slurred speech
- Vision problems in one eye
- Dizziness
- Pulsating sound in the ear (pulsatile tinnitus)
- Horner's syndrome (drooping eyelid, constricted pupil, and reduced sweating on one side of the face)
This condition requires immediate medical attention as it's a significant cause of stroke in younger adults. Treatment typically involves anticoagulation or antiplatelet therapy (such as heparin, warfarin, aspirin, or clopidogrel) for 3-6 months to prevent clot formation while the vessel heals 1. In severe cases with significant narrowing or recurring strokes despite medication, endovascular stenting or surgery may be necessary 1.
Importance of Early Diagnosis
Early diagnosis and treatment are crucial to prevent further complications, such as stroke or death. The diagnostic algorithm begins with clinical examination and brain imaging, followed by vascular imaging when an ischemic cause is suspected 1. Carotid duplex ultrasonography, CTA, or MRA are commonly used for diagnosis of extracranial dissection.
Treatment Options
- Anticoagulation or antiplatelet therapy
- Endovascular stenting or surgery in severe cases
- Conservative observation without specific medical therapy in some cases
It's essential to note that the optimal strategy for prevention of stroke in patients with arterial dissection is controversial, and treatment should be individualized based on the patient's specific condition and medical history 1.
From the Research
Carotid Dissection Symptoms
The symptoms of carotid dissection can vary, but common symptoms include:
- Headache, which can be unilateral and is often the initial manifestation 2
- Neck pain, which can be anterolateral in internal carotid artery dissection (ICAD) and posterior in vertebral artery dissection (VAD) 2
- Facial pain 3
- Eye pain 2
- Ear pain 2
- Oculosympathetic paresis 3
- Horner's syndrome 4
- Pulsatile tinnitus 4, 5
- Cranial nerve deficits 3
- Transient or persistent brain ischemia, including stroke and transient ischemic attack 4, 5
- Retinal artery occlusion, which can cause visual loss 6
- Subjective carotid bruits 3
Characteristics of Headache in Carotid Dissection
The characteristics of headache in carotid dissection can include:
- Ipsilateral to the side of dissection 2
- Steady or pulsating 2
- Limited to the anterior head in ICAD and posterior in VAD 2
- Median duration of 72 hours, but can persist for months to years in some cases 2
Other Symptoms
Other symptoms that can occur in carotid dissection include: