Carotid Dissection may result from neck extension combined with lateral bending to the opposite side, or trauma from an incorrectly placed shoulder belt tightening across the neck in a motor vehicle accident. Extension/bending stretches the carotid over the bony transverse processes of the cervical vertebrae, while seat belt injuries cause direct trauma. Symptoms of cervical carotid dissection include contralateral neurologic deficit from brain ischemia, headache, and ipsilateral Horner's syndrome from disruption of the sympathetic tracts ascending from the stellate ganglion into the head on the surface of the carotid artery. The patient may complain of hearing or feeling a bruit.
Traumatic vessel wall injury to the portion of the carotid artery running through the cavernous sinus may result in a carotid-cavernous fistula (CCF). This creates a high-pressure, high-flow pathophysiologic blood flow pattern. CCFs classically present with pulsatile proptosis (the globe pulses outward with arterial pulsation), retro-orbital pain, and decreased visual acuity or loss of normal eye movement (due to damage to cranial nerves III, IV, and VI as they pass through the cavernous sinus). Symptomatic CCFs should be treated to preserve eye function. Fistulae may be closed by balloon occlusion using interventional neuroradiology techniques. Fistulae with wide necks are difficult to treat and may require total occlusion of the parent carotid artery.
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Topic: Carotid Dissection (Read 330 times)