Artery Dissection

Carotid artery dissection is a tear in the interior lining of one of the main vessels in the neck that carries blood to the brain. Blood may make its way through the tear and channel into the lining of the artery. It may act like a tourniquet or cause a clot that breaks off and travels to the brain resulting in a stroke

Trauma-related dissection, caused by a blow or a cut to the neck, is more common than spontaneous dissection, which might be caused by a sudden turn of the neck. Its symptoms may include headache, neck pain, weakness, dizziness, drooping of an eyelid and small pupils. It can be detected via angiography or magnetic resonance imaging, in which a substance is injected into the body and followed through the bloodstream

Causes

• spontaneous underlying
• arteriopathy
• fibromuscular dysplasia
• trauma
• Chiropractic manipulation and leaning backward while getting hair washed at the beauty salon are examples of simple traumatic injury possibilities to the carotid artery that might cause carotid artery dissection. Chiropractic Manipulation and Stroke — Abstracts: Rothwell et al. 32 (5): 1054

The cervical internal carotid artery is affected in 75% of patients usually approximately 2 cm distal to the bifurcation and the extracranial vertebral artery in 15% of patients. The remaining cases usually involve the intracranial internal carotid artery, intracranial vertebral artery, middle cerebral artery or basilar artery. Cevicocephalic dissections may occur spontaneously or secondary to major or minor trauma. In some patients they are associated with underlying arteriopathy. 15% of cases are bilateral and 1/2 of these occur in patients with fibromuscular dysplasia. eMedicine - Dissection Syndromes : Article by Chelsea Kidwell, MD

The blood is forced through a defect in the inner wall of your artery by arterial pressure. As a result, the blood column doesn’t travel through the normal “canal” at the center of the vessel, but may deviate into the area between the inner layer of the vessel and the middle layer. This deviated blood can actually cause a new pathway for a distance along the vessel. A haematoma (swelling/clotted blood) forms in the arterial wall causing an occlusion or what is termed a dissecting aneurysm . People with hypertension (high blood pressure) or cystic medial necrosis are particularly susceptible to this type of dissection. Strokes are most commonly caused by carotid dissections, vertebral or vertebobasilar and sometimes by aortic dissections.

There are several areas near the aorta that dissect

• Dissection is in the closest part of the Ascending Aorta (coming out of the heart), you may experience pain centered in the part of your chest just below where all your ribs come together near where you think your stomach would be. This is called the mid-substernal area
• Dissection is away from your heart but still in the Ascending Aorta, you may feel pain between your wing blades (scapula) at your upper back
• In certain types of dissection, the pain may move from the front chest area to the neck, then to your upper back and eventually involve much of the middle back. This is considered a Migratory Pattern of painand is often associated with aortic dissections

Usually, the initial pain is a sudden, severe, new type of pain in your chest and may be similar to having ischemic heart problems. With ischemic heart problems, the pain builds over time to a crescendo and resting will decrease the pain

Often, your blood tests, chest x-rays, and EKG (electrocardiogram) may be normal

Management and Treatment

There is not conclusive evidence for use of either aspirin or anticoagulants. For more information

• eMedicine - Dissection, Carotid Artery: Article by Sean O Henderson, MD
• VAD Club
• Cervical Arterial Dissection Stroke — Abstracts: Beletsky et al. 34 (12): 2856

References

Carotid artery Dissection emedicine

Agarwal, A Khan,I D.*& Dasgupta, T, Spontaneous Extra Cranial Artery Dissection - Ishchaemic Stroke In Young