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Spontaneous dissection of both extracranial internal carotid arteries
L Milandre1, S Pérot, G Salamon
1Department of Neurology, CHU Timone, Marseille, France.
Insights
Bilateral internal carotid artery dissection, though often asymptomatic, is frequently linked to fibromuscular dysplasia. This condition may present similarly to unilateral carotid dissection, highlighting the need for comprehensive vascular assessment.
Area of Science:
- Vascular Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Spontaneous carotid artery dissection is a significant cause of stroke, particularly in younger adults.
- While unilateral dissection is more commonly reported, bilateral involvement warrants careful consideration.
- Fibromuscular dysplasia is a known predisposing factor for arterial dissections.
Observation:
- A 50-year-old patient presented with symptoms suggestive of left internal carotid artery dissection, including headaches, amaurosis fugax, Horner's syndrome, and stroke.
- Four-vessel angiography revealed dissection in both extracranial carotid arteries, more severe on the right side, which was asymptomatic.
- Follow-up angiography demonstrated recanalization of both dissected carotid arteries.
Findings:
- Bilateral internal carotid artery dissection, as observed in this case and supported by a review of 15 reports, is often associated with fibromuscular dysplasia.
- The clinical presentation of bilateral carotid dissection frequently mimics that of unilateral dissection, potentially delaying diagnosis.
- Recanalization of dissected carotid arteries can occur spontaneously over time.
Implications:
- This case underscores the importance of considering bilateral carotid artery dissection even with unilateral symptoms.
- Screening for fibromuscular dysplasia may be beneficial in patients diagnosed with spontaneous carotid dissection, especially when bilateral.
- Further research into the natural history and optimal management of bilateral carotid artery dissection is warranted.
Abstract:
Neurological examination and Doppler sonography of a 50-year-old patient were suggestive of a spontaneous dissection of the left internal carotid artery (left-sided headaches, amaurosis fugax, Horner's syndrome and hemispheric stroke). Four-vessel angiogram performed several days after the onset of the symptoms showed dissection of both extracranial carotid arteries, more pronounced on right side where the dissection was clinically asymptomatic. Angiogram follow-up demonstrated a recanalization of both carotid arteries. A review of 15 other documented reports indicates that bilateral internal carotid dissection is usually associated with fibromuscular dysplasia. A large majority of cases does not clinically differ from unilateral carotid artery dissection.