Images in Clinical Medicine
Kim Eagle, M.D., Editor
Traumatic Carotid-Artery Dissection
N Engl J Med 1996; 335:1368October 31, 1996
- Article
Figure 1 A 35-year-old woman fell off her bicycle, striking her chin on the pavement. She initially reported bilateral neck pain and headache and later had photophobia and weakness and paresthesia in the right arm. Examination revealed anisocoria but no other neurologic findings.
Magnetic resonance imaging confirmed the presence of bilateral dissections, beginning with tears in the extracranial internal carotid arteries anterior to the upper cervical vertebrae and extending distally into the intracranial siphon. (The inverted A denotes anterior orientation.) These lesions are uncommon, accounting for less than 5 percent of all carotid injuries, but they are diagnosed more frequently with improved cerebrovascular imaging. The “eyes of dissection” are composed of the dark flow-void “pupils” surrounded by the high-intensity signal of intramural hematoma. A small pseudoaneurysm was present on the left side. The patient was given anticoagulant therapy and had no further focal neurologic symptoms. After 10 months and radiographic confirmation of healing, the anticoagulation was discontinued and the patient was well.
Kim Eagle, M.D.
Jon S. Matsumura, M.D.
William H. Pearce, M.D.
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