Arterial Dissection

Dissection of the cervical carotid and vertebral arteries may occur spontaneously or due to trauma to the head or neck. It is an important cause of death in the young and middle-aged. Rupture of the arterial wall produces

FIGURE 4.43

Arterial dissection. Nontraumatic massive mural hematoma in a carotid endarterectomy specimen.

FIGURE 4.43

Arterial dissection. Nontraumatic massive mural hematoma in a carotid endarterectomy specimen.

an intramural hemorrhage and subsequent luminal reduction (Fig. 4.43). It carries the risk of local thrombosis and embolization. The pathogenesis is poorly understood: Weakness of the arterial wall and fibromus-cular dysplasia predispose to dissection.

A dissection of the carotids and vertebrals presents with unilateral headaches, neck pain, Horner syndrome, ipsilateral cranial nerve deficits, and TIAs. It may culminate in a cerebral hemispheric or brainstem infarct. Angiogram confirms the diagnosis by demonstrating segmental luminal narrowing (string sign).

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