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Carotid Artery Dissection in Neck
H. Y. Yuen, MBChB, FRCR; K. T. Wong, MBChB, FRCR; Carmen C. Cho, MBBS, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Carotid artery dissection (CAD)
            • Common carotid artery dissection (CCAD)
            • Internal carotid artery dissection (ICAD)
          • Definitions

            • CAD: Tear in carotid artery wall allows blood to enter and delaminate wall layers and create false lumen

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Ansari SA et al: Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent. Neurosurgery. 62(3):636-46; discussion 636-46, 2008
                                    2. Chandra A et al: Spontaneous dissection of the carotid and vertebral arteries: the 10-year UCSD experience. Ann Vasc Surg. 21(2):178-85, 2007
                                    3. Wu HC et al: Spontaneous bilateral internal carotid artery dissection with acute stroke in young patients. Eur Neurol. 56(4):230-4, 2006
                                    4. Biondi A et al: Progressive symptomatic carotid dissection treated with multiple stents. Stroke. 36(9):e80-2, 2005
                                    5. Edgell RC et al: Endovascular management of spontaneous carotid artery dissection. J Vasc Surg. 42(5):854-60; discussion 860, 2005
                                    6. Knibb J et al: Internal carotid artery dissection presenting with ipsilateral tenth and twelfth nerve palsies and apparent mass lesion on MRI. Br J Radiol. 78(931):659-61, 2005
                                    7. Roz TM et al: Spontaneous dissection of the internal carotid artery manifesting as pain in an endodontically treated molar. J Am Dent Assoc. 136(11):1556-9, 2005
                                    8. Benninger DH et al: Mechanism of ischemic infarct in spontaneous carotid dissection. Stroke. 35(2):482-5, 2004
                                    9. Kono Y et al: Carotid arteries: contrast-enhanced US angiography--preliminary clinical experience. Radiology. 230(2):561-8, 2004
                                    10. Payton TF et al: Traumatic dissection of the internal carotid artery. Pediatr Emerg Care. 20(1):27-9, 2004
                                    11. Dziewas R et al: Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 250(10):1179-84, 2003
                                    12. Irie K et al: Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization. Neuroradiology. 45(11):825-9, 2003
                                    13. Nadgir RN et al: Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 45(5):311-4, 2003
                                    14. Logason K et al: Duplex scan findings in patients with spontaneous cervical artery dissections. Eur J Vasc Endovasc Surg. 23(4):295-8, 2002
                                    15. Brandt T et al: Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology. 57(1):24-30, 2001
                                    16. Duncan MA et al: Traumatic bilateral internal carotid artery dissection following airbag deployment in a patient with fibromuscular dysplasia. Br J Anaesth. 85(3):476-8, 2000
                                    17. Malek AM et al: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol. 21(7):1280-92, 2000
                                    18. Saito R et al: Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect. Surg Neurol. 53(4):318-22, 2000
                                    19. Biffl WL et al: Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 47(5):845-53, 1999
                                    20. Bousson V et al: Dissections of the internal carotid artery: three-dimensional time-of-flight MR angiography and MR imaging features. AJR Am J Roentgenol. 173(1):139-43, 1999
                                    21. Nusbaum AO et al: Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery. AJNR Am J Neuroradiol. 19(10):1845-7, 1998
                                    22. Pica RA Jr et al: Traumatic internal carotid artery dissection presenting as delayed hemilingual paresis. AJNR Am J Neuroradiol. 17(1):86-8, 1996
                                    23. Provenzale JM: Dissection of the internal carotid and vertebral arteries: imaging features. AJR Am J Roentgenol. 165(5):1099-104, 1995
                                    24. Sturzenegger M et al: Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology. 45(4):691-8, 1995
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Carotid artery dissection (CAD)
                                              • Common carotid artery dissection (CCAD)
                                              • Internal carotid artery dissection (ICAD)
                                            • Definitions

                                              • CAD: Tear in carotid artery wall allows blood to enter and delaminate wall layers and create false lumen

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Angiographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Ansari SA et al: Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent. Neurosurgery. 62(3):636-46; discussion 636-46, 2008
                                                                      2. Chandra A et al: Spontaneous dissection of the carotid and vertebral arteries: the 10-year UCSD experience. Ann Vasc Surg. 21(2):178-85, 2007
                                                                      3. Wu HC et al: Spontaneous bilateral internal carotid artery dissection with acute stroke in young patients. Eur Neurol. 56(4):230-4, 2006
                                                                      4. Biondi A et al: Progressive symptomatic carotid dissection treated with multiple stents. Stroke. 36(9):e80-2, 2005
                                                                      5. Edgell RC et al: Endovascular management of spontaneous carotid artery dissection. J Vasc Surg. 42(5):854-60; discussion 860, 2005
                                                                      6. Knibb J et al: Internal carotid artery dissection presenting with ipsilateral tenth and twelfth nerve palsies and apparent mass lesion on MRI. Br J Radiol. 78(931):659-61, 2005
                                                                      7. Roz TM et al: Spontaneous dissection of the internal carotid artery manifesting as pain in an endodontically treated molar. J Am Dent Assoc. 136(11):1556-9, 2005
                                                                      8. Benninger DH et al: Mechanism of ischemic infarct in spontaneous carotid dissection. Stroke. 35(2):482-5, 2004
                                                                      9. Kono Y et al: Carotid arteries: contrast-enhanced US angiography--preliminary clinical experience. Radiology. 230(2):561-8, 2004
                                                                      10. Payton TF et al: Traumatic dissection of the internal carotid artery. Pediatr Emerg Care. 20(1):27-9, 2004
                                                                      11. Dziewas R et al: Cervical artery dissection--clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 250(10):1179-84, 2003
                                                                      12. Irie K et al: Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization. Neuroradiology. 45(11):825-9, 2003
                                                                      13. Nadgir RN et al: Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 45(5):311-4, 2003
                                                                      14. Logason K et al: Duplex scan findings in patients with spontaneous cervical artery dissections. Eur J Vasc Endovasc Surg. 23(4):295-8, 2002
                                                                      15. Brandt T et al: Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology. 57(1):24-30, 2001
                                                                      16. Duncan MA et al: Traumatic bilateral internal carotid artery dissection following airbag deployment in a patient with fibromuscular dysplasia. Br J Anaesth. 85(3):476-8, 2000
                                                                      17. Malek AM et al: Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty. AJNR Am J Neuroradiol. 21(7):1280-92, 2000
                                                                      18. Saito R et al: Combined neuroendovascular stenting and coil embolization for cervical carotid artery dissection causing symptomatic mass effect. Surg Neurol. 53(4):318-22, 2000
                                                                      19. Biffl WL et al: Blunt carotid arterial injuries: implications of a new grading scale. J Trauma. 47(5):845-53, 1999
                                                                      20. Bousson V et al: Dissections of the internal carotid artery: three-dimensional time-of-flight MR angiography and MR imaging features. AJR Am J Roentgenol. 173(1):139-43, 1999
                                                                      21. Nusbaum AO et al: Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery. AJNR Am J Neuroradiol. 19(10):1845-7, 1998
                                                                      22. Pica RA Jr et al: Traumatic internal carotid artery dissection presenting as delayed hemilingual paresis. AJNR Am J Neuroradiol. 17(1):86-8, 1996
                                                                      23. Provenzale JM: Dissection of the internal carotid and vertebral arteries: imaging features. AJR Am J Roentgenol. 165(5):1099-104, 1995
                                                                      24. Sturzenegger M et al: Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology. 45(4):691-8, 1995