Carotid Dissection

A carotid dissection is a tear in the inner layer of an artery in the neck. You have 1 carotid artery on each side of your neck. These arteries send blood to your brain.

What happens during a tear in a carotid

The first part of each carotid artery is the called the common carotid artery. Each common carotid artery has an inner (internal) and an outer (external) branch. The outer branch carries blood to your face and scalp. The inner branch carries blood to the front part of your brain.

A carotid dissection is a tear of the inner layer of the wall of the artery. The tear lets blood get in between the layers of the wall. This separates them and causes the artery wall to bulge. The bulge can slow or stop blood flow through the artery. It can also cause problems by pressing on things nearby, such as nerves.

The tear can also start the body's clotting system. A clot can then block blood flow at the site of the tear. Or pieces of the clot can break off and block blood flow in smaller branches of the artery. Blocked or decreased blood flow can lead to a mini-stroke (TIA) or stroke. These stop blood flow to the brain. A TIA does this for only a short period of time.

A carotid dissection can happen at any age. It tends to happen more often in younger adults than in older adults. It is a common cause of stroke in people under age 50.

What causes carotid dissection?

An injury to the neck can cause carotid dissection. The injury may be caused by something like a car crash. A carotid dissection can also happen with no known cause. Or it may happen after a normal activity such as:

  • Swimming

  • Scuba diving

  • Skating

  • Dancing

  • Play sports such as tennis, basketball, or volleyball

  • Yoga

  • Riding a roller coaster or other ride

  • Jumping on a trampoline

  • Giving birth

  • Having sex

  • Sneezing or coughing

  • Getting chiropractic treatment

Risks for carotid dissection

Some things may raise the risk of having a carotid dissection. But some people who get carotid dissections do not have any of those risk factors. In some cases, genes may play a part. If you have a family member who has had an artery dissection, you may have a greater risk. Other things that may raise your risk:

  • Infection

  • High blood pressure

  • Migraine headaches

  • Smoking

  • Use of oral contraceptives

  • Alcohol use

  • An extra-long bone near the jaw (styloid process)

Symptoms of carotid dissection

You may not have symptoms. Or they may happen quickly, or happen over several days. Common symptoms are:

  • Headache

  • Scalp pain

  • Eye pain

  • Neck pain

  • One eye with a droopy lid and small pupil (partial Horner syndrome)

  • One-sided weakness or numbness

  • Pulsing sound in an ear

  • Trouble swallowing

  • Abnormal or lost sense of taste

Diagnosing carotid dissection

Your health care provider will ask about your past health and your symptoms. He or she may ask about recent injuries and activities. During the exam, your doctor may look at your face and eyes, strength, reflexes, and areas of numbness. If you may have a health problem that raises your risk for carotid dissection, you may need more tests. Your doctor may refer you to a neurologist, vascular surgeon, or neurosurgeon.

Tests may also be done to rule out other problems. These can include different types of headaches, nerve disorders, bleeding of the brain, and stroke from other causes. Tests may include:

  • Blood tests

  • Lumbar puncture with study of your cerebrospinal fluid

  • MRI of the brain

  • Magnetic resonance angiography (MRA) of the brain

  • Cranial CT scan

  • Cranial CT angiography (CTA)

Treatment for carotid dissection

You may need to be treated in a hospital. Treatment choices depend on your age, overall health, and symptoms. Treatment may include:

  • Clot-busting medicine (thrombolytic), if your dissection caused a stroke

  • Heparin to prevent more blood clots

  • Fluids given by IV

  • Blood pressure medicine

  • Insulin or glucose to control your blood sugar

  • Pain medicine

  • Antiplatelet medicine, such as aspirin

  • Blood-thinning medicine, such as warfarin

You may need to take blood-thinning medicine for 3 to 6 months. At that point you may need imaging studies to see how your carotid artery is healing.

If you have problems with repeated carotid dissection, your doctor may tell you to get other treatment. You may need surgery to put in a stent, or to fix or bypass the artery.

 

When to call 911

Call 911 if you have symptoms of TIA or stroke. These include:

  • Sudden drooping, numbness, or weakness of your face

  • Sudden numbness or weakness or an arm or leg

  • Sudden trouble speaking

  • Sudden confusion

  • Sudden trouble seeing in one or both eyes

  • Sudden trouble walking, dizziness, lack of balance or coordination

  • Sudden severe headache with no known cause