Carotid artery dissection is a very rare occurrence which involves a tear or break forming in the carotid artery of the neck. A dissection occurs when the lining and/or wall of the artery tears. This tear can either be complete or only partial. When a partial tear occurs, the inner lining of the artery pulls away from the outer lining and causes a second lumen, or hole, to form. Carotid artery dissections are very serious because they can quickly cause an intracranial aneurysm which could lead to a subarachnoid bleed. Dissections outside of the cranium rarely form aneurysms. Carotid artery dissections are responsible for up to twenty percent of strokes in young adults, although this percentage is thought to be higher because many go undiagnosed. They are the leading cause of ischemic strokes in persons under the age of fifty. These dissections can be cause by a number of reasons either spontaneous or through trauma. One should be especially concerned about a possible dissection when direct trauma or stress occurs at the cervical level. Dissections can also occur from quick movements of the neck or by holding the neck in the same position for extended amounts of time. Carotid artery dissections have been noted in patients who were doing sports activities, had appointments with the chiropractor, and who were doing overhead painting. In extremely rare cases, dissection can occur simply by sneezing or coughing. Dissections inside the cranium are extremely rare because the skull absorbs most of the impact in traumatic events. The most common symptoms of a dissection are a headache occurring on the opposite side of the dissection, bruising and swelling of one side of the neck, visual disturbances such as flashing and arcing lights, blindness due to decreased blood flow to the retina, decreased taste, and pain of the face, head, and neck. Smoking, oral birth control, respiratory tract infections, high blood pressure, and genetics all increase your susceptibility of having a spontaneous dissection. Dissections can be diagnosed through ultrasound, MRI/MRA, CTA, or angiography, which had been the standard diagnosing tool for many years until recently. Patients with a Carotid artery dissection have a good prognosis if it is caught early. Patients are often medicated with Heparin or some type of thrombolytic medication. Surgery is often not required but in some cases patients must have a balloon stenting procedure done.
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