Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum

Cervical cephalic dissections are uncommon acute disruptions of the arterial wall occurring predominantly in middle-aged women. Clinically, most patients present with unilateral headache, oculosympathetic palsy, or ischemic neurologic symptoms. Usually, a single internal carotid artery, predominantly the right, is affected, but simultaneous multivessel dissections are evident in about one-third of patients. Angiographically, the appearance of the dissection varies, depending on its severity, extent, and the interval between onset and angiography. In the patients reported, the disruption was manifested initially by eccentric tapered stenosis in 47%, tapered stenosis and a dissecting aneurysm in 28%, occlusion in 18%, or a dissecting aneurysm alone in 7%. Subsequently, stenotic dissections resolved in 60%, improved in 20%, and progressed in 15%, while dissecting aneurysms diminished in half and resolved in one-fourth of patients. An angiographic residuum, temporally remote to its onset, was evident in 25% of dissections. Hence, carotid arterial dissections tend to resolve, sometimes progress, but seldom recur.