INTERNAL CAROTID-ARTERY DISSECTION - AN UPDATE

Carotid artery dissection is a major cause of cerebral infarction in t he young. The extracranial portion of the internal carotid artery is m uch more frequently involved than the intracranial portion. In up to 2 0% of cases it is bilateral or associated with vertebral artery dissec tion. It is mainly characterised by local signs such as headache or fa cial pain, Horner's syndrome, lower cranial nerve palsies and pulsatil e tinnitus, followed a few hours or days later by signs of cerebral or retinal ischemia. Ultrasound investigations show signs of distal sten osis or occlusion, highly suggestive of dissection, but the best diagn ostic tool is presently the association of magnetic resonance imaging (MRI) and MR angiography which tend to replace intra-arterial angiogra phy. The prognosis is highly variable: excellent in cases limited to l ocal signs, but very poor leading to death or major sequelae in about 15% of cases, Various treatments have been suggested but no controlled trial has ever been performed in this condition. Heparin in the acute stage followed by warfarin or aspirin for 3 to 6 months is most commo nly used. (C) 1998 Elsevier Science B.V.