Carotid dissection with and without ischemic events - Local symptoms and cerebral artery findings

Objective: To study whether spontaneous dissections of the cervical interna l carotid artery dissection (ICAD) with and without ischemia of the brain o r retina differ in the prevalence of vascular risk factors, local neurologi c signs and symptoms, and stenoses and occlusions of the cerebral arteries. Methods: The authors prospectively studied 181 consecutive patients with 2 00 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiogr aphy. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carot id and basal cerebral arteries were evaluated. Results: ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05) , >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial ob structions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001). Conclusions: These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to i ntracranial obstructions and cerebral or retinal ischemic events. Conversel y, ICAD without luminal narrowing cause more local signs and symptoms.