BILATERAL INTERNAL CAROTID-ARTERY DISSECTION FROM VOMITING

Dissection of the internal carotid artery is responsible for approxima tely 5% of ischemic strokes in adults. The pathophysiology of dissecti on can be either traumatic or spontaneous. The true incidence of spont aneous dissection is unknown. Once considered very rare, an increased aware ness, combined with noninvasive evaluation by ultrasound and mag netic resonance angiography, has demonstrated a more frequent occurren ce. Trivial trauma (ie, rather than external blunt or penetrating trau ma) such as vomiting has rarely been documented as causing bilateral d issection. It is well recognized by neurologists but often not by othe r physicians. Prognosis is good, but delay in diagnosis may result in residual neurologic deficits. tt should therefore be suspected early e specially in younger patients presenting with transient ischemic attac ks or stroke. Copyright (C) 1998 by W.B. Saunders Company.