Correspondence

Carotid-Artery Dissection after a Prolonged Telephone Call

N Engl J Med 1997; 336:516February 13, 1997

Article

To the Editor:

The mechanisms and severity of trauma associated with dissection of the internal carotid artery vary. Participation in many types of sports, prolonged hypertension, forced rotation of the head, and various routine activities are all potentially causative.1

A 36-year-old woman with an unremarkable medical history had sudden right-sided neck pain immediately after a telephone conversation that lasted 32 minutes, as timed by the counter on the base unit of her cordless phone. During the entire conversation, she held the handset between her right ear and shoulder by flexing her head to the side, thereby allowing her to continue ironing. The cervical pain was followed by an ipsilateral pulsatile tinnitus. A detailed neurologic examination was unrevealing. There was no history of hypertension, migraine, or smoking. Estrogen–progestin contraceptive therapy was discontinued at the time of admission to the hospital.

Computed tomography, Doppler sonography, and magnetic resonance angiography of the cervical arteries confirmed the diagnosis of extracranial right internal-carotid-artery dissection. The lumen was almost completely occluded by an intramural hematoma. Internal-carotid redundancy was not observed.2 Laboratory tests, including coagulation studies and digital intravenous angiography of the abdominal aorta and renal arteries, did not suggest a constitutional or acquired predisposing arterial disease.3,4 The patient was given anticoagulant therapy with warfarin for three months. The cervical pain lasted about 20 hours, and the pulsatile tinnitus about 48 hours. Follow-up magnetic resonance angiography confirmed complete recanalization of the carotid artery. During six months of follow-up, the patient has not had recurrent symptoms.

Internal-carotid-artery dissection is increasingly recognized as a major cause of ischemic stroke in young people.5 The widespread use of cordless phones favors long-lasting communications by facilitating the simultaneous performance of other activities. We believe that the prolonged lateral flexion of the head in this patient during her telephone conversation may have led to dissection of the carotid artery.

Jean-Jacques Mourad, M.D.
Xavier Girerd, M.D., Ph.D.
Michel Safar, M.D.
Hôpital Broussais, 75014 Paris, France

5 References

1. 1

   Mokri B. Dissections of cervical and cephalic arteries. In: Sundt TM Jr, ed. Occlusive cerebrovascular disease: diagnosis and surgical management. Philadelphia: W.B. Saunders, 1987:38-59.
   

2. 2

   Barbour PJ, Castaldo JE, Rae-Grant AD, et al. Internal carotid artery redundancy is significantly associated with dissection. Stroke 1994;25:1201-1206
   CrossRef | Web of Science | Medline

3. 3

   Hart RG, Easton JD. Dissections of cervical and cerebral arteries. Neurol Clin 1983;1:155-182
   Medline

4. 4

   Mas JL, Bousser MG, Hasboun D, Laplane D. Extracranial vertebral artery dissections: a review of 13 cases. Stroke 1987;18:1037-1047
   CrossRef | Web of Science | Medline

5. 5

   Schievink WI, Mokri B, O'Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med 1994;330:393-397
   Full Text | Web of Science | Medline

Citing Articles (4)

Citing Articles

1. 1

   Konstantinos P. Donas, Dieter Mayer, Ivo Guber, Ralf Baumgartner, Michele Genoni, Mario Lachat. (2008) Endovascular Repair of Extracranial Carotid Artery Dissection: Current Status and Level of Evidence. Journal of Vascular and Interventional Radiology 19:12, 1693-1698
   CrossRef

2. 2

   Branko Petrovic, Djordje Radak, Vladimir Kostic, Nadezda Covickovic-Sternic. (2008) Styloid syndrome: A review of literature. Srpski arhiv za celokupno lekarstvo 136:11-12, 667-674
   CrossRef

3. 3

   William J. Benedict, Vikram Prabhu, Mari Viola, Josè Biller. (2007) Carotid artery pseudoaneurysm resulting from an injury to the neck by a fouled baseball. Journal of the Neurological Sciences 256:1-2, 94-99
   CrossRef

4. 4

   R.R Singh, M.C Barry, A Ireland, D Bouchier Hayes. (2004) Current Diagnosis and Management of Blunt Internal Carotid Artery Injury. European Journal of Vascular and Endovascular Surgery 27:6, 577-584
   CrossRef