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Internal carotid artery dissection following self-manipulation: A case report
Kurt Piening1, Nicholas M Piening1, Andy Chiou1
1Department of Surgery, The University of Illinois College of Medicine Peoria, Peoria, IL, USA.
Insights
A rare case of internal carotid artery dissection in a young woman, caused by self-neck manipulation, was successfully treated with anticoagulation and antiplatelet medication. Follow-up imaging showed complete resolution of the dissection and significant symptom improvement.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Cervical artery dissection is a significant cause of stroke in young adults.
- Symptoms include pain, Horner syndrome, and cranial neuropathies.
- Treatment typically involves anticoagulation, with surgery reserved for severe or recurrent cases.
Observation:
- A healthy 26-year-old female presented with internal carotid artery dissection after self-manipulation of the neck.
- She developed Horner syndrome and significant arterial narrowing.
- This cause of dissection is rare, unlike those reported after professional chiropractic manipulation.
Findings:
- The patient was treated with anticoagulation, transitioning to clopidogrel and atorvastatin.
- Six-month follow-up computed tomography angiography revealed complete resolution of the dissection.
- Significant improvement in symptoms was noted, with only mild residual ptosis.
Implications:
- This case highlights a rare cause of internal carotid artery dissection.
- Successful medical management of spontaneous dissections is demonstrated.
- It underscores the importance of considering self-manipulation as a potential trigger for cervical artery dissection.
Abstract:
Arterial dissections are a common cause of stroke in young patients. Dissection occurs when the structure of the arterial wall is compromised, allowing blood to collect between layers as an intramural hematoma. Symptoms of cervical artery dissection may include pain, Horner syndrome, cranial and cervical neuropathies, and pulsatile tinnitus. Treatment varies depending on the severity of symptoms but generally includes anticoagulation with surgical therapy reserved for patients with progressive neurologic symptoms or symptom recurrence while on maximum medical therapy. Here, we present the case of a traumatic internal carotid artery dissection with significant narrowing of the artery in a healthy 26-year-old female after self-manipulation of the neck. She developed Horner syndrome secondary to her dissection. Our patient was initially treated with anticoagulation and transitioned to clopidogrel and atorvastatin for outpatient treatment. Six-month follow-up computed tomography angiography showed complete resolution of her dissection. She had overall significant improvement in her symptoms with only mild residual ptosis on the follow-up examination. While the presentation of a patient with neurologic sequelae from a cervical artery dissection causing stroke is a well-known phenomenon, the mechanical cause in this particular case is rare. There have been several case reports in the literature detailing cervical artery dissections following cervical manipulative therapy by trained professionals (i.e. chiropractors, physical therapists, osteopathic physicians) but none occurring from self-manipulation of the neck. This case report details successful treatment of a rare case of internal carotid dissection following self-manipulation with appropriate medical therapy.
