Differential Diagnosis for Carotid and Vertebral Artery Dissection in a 35-Year-Old Female

Single Most Likely Diagnosis

• Trauma: This is often the most common cause of carotid and vertebral artery dissection, especially in younger individuals. Even minor trauma can lead to dissection, especially if there is an underlying vascular anomaly or condition.

Other Likely Diagnoses

• Fibromuscular Dysplasia (FMD): A non-atherosclerotic, non-inflammatory vascular disease that affects medium- and large-sized arteries, most commonly the renal and internal carotid arteries. It can lead to dissection and is more common in young women.
• Connective Tissue Disorders: Conditions like Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta can increase the risk of arterial dissection due to the inherent weakness in the arterial wall.
• Hypertension: Uncontrolled high blood pressure can lead to arterial wall stress and increase the risk of dissection.

Do Not Miss Diagnoses

• Vasculitis: Inflammatory diseases of the blood vessels, such as giant cell arteritis or Takayasu arteritis, can cause dissection and are critical to diagnose due to their potential for severe complications and the need for specific treatment.
• Drug-Induced Vasculitis or Vasoconstriction: Certain drugs can cause vasculitis or severe vasoconstriction leading to dissection. Identifying and stopping the offending drug is crucial.
• Infectious Causes: Although rare, infections can cause or contribute to arterial dissection, either through direct invasion of the arterial wall or through an inflammatory response.

Rare Diagnoses

• Spontaneous Dissection: Without any identifiable cause, some dissections occur spontaneously, possibly due to an inherent weakness in the arterial wall or other undiagnosed conditions.
• Genetic Disorders: Besides connective tissue disorders, other genetic conditions can predispose to arterial dissection, such as pseudoxanthoma elasticum or arterial tortuosity syndrome.
• Cervical Spine Manipulation: There is a rare but recognized association between cervical spine manipulation and vertebral artery dissection, likely due to the mechanical stress on the artery during the procedure.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and diagnostic imaging to determine the underlying cause of the carotid and vertebral artery dissection.