What is carotid dissection?

A carotid dissection is a tear in 1 of your carotid arteries. You have a set of 2 carotid arteries at the sides of your neck. They supply blood to your brain.

A dissection is a tear of the inner layer of the wall of an artery. The tear lets blood get in between the layers of the wall and separate them. This causes the artery wall to bulge. The bulge can slow or stop blood flow through the artery. It can also cause problems by pressing on nearby tissue or nerves. 

The tear can also set off your body's clotting system. A clot can then block blood flow at the site of the tear. Or pieces of the clot can break off. These can block blood flow in smaller branches of the artery. Blocked or decreased blood flow can lead to a transient ischemic attack (TIA) or a stroke.

A carotid dissection can happen at any age. It tends to happen more often in younger adults than in older adults. It is a common cause of stroke in people younger than age 50. It's slightly more common in men than in women.

What causes carotid dissection?

This condition is often caused by a neck injury. The injury may be due to a car accident. Or it may be from some other type of injury that causes extreme neck rotation or extension.

Some people have health conditions that can weaken artery walls. This makes them at higher risk for a dissection.  Many of these dissections occur suddenly. In these cases, the person often does not recall any neck injury.

A dissection can occur with some physical activity, such as:

• Swimming or scuba diving.

• Skating.

• Dancing.

• Playing sports, such as tennis, basketball, or volleyball.

• Doing yoga.

• Riding roller coasters or other rides.

• Jumping on a trampoline.

• Giving birth.

• Having sex.

• Sneezing or coughing.

• Having a chiropractic adjustment to your neck (rare).

 A carotid dissection can also occur with no known cause.

Who is at risk for carotid dissection?

Some factors can increase your risk. But some people who have a dissection don't have any of those risk factors.

In some cases, certain genes may increase your risk. If you have a family member who had an artery dissection, you may be more at risk. Other things that may increase your risk include:

• Infection.

• High blood pressure.

• Migraine headaches.

• Smoking.

• Using birth control pills.

• Alcohol use.

• Low cholesterol levels.

If you have 1 of the below health conditions, you are also at higher risk:

• A long styloid process, a small part of bone near the jaw (Eagle syndrome, rare)

• Fibromuscular dysplasia

• Ehlers-Danlos syndrome

• Marfan syndrome

• Homocystinuria

• Alpha-1 antitrypsin deficiency

• Osteogenesis imperfecta

• Cystic medial necrosis of the aorta

• Segmental mediolytic arteriopathy

• Reticular fiber deficiency

• Reversible cerebral vasoconstriction syndrome

• Autosomal dominant polycystic kidney disease

What are the symptoms of carotid dissection?

Some people don't have any symptoms. In other cases, symptoms may occur suddenly or over a few days. They may include:

• Headache.

• Scalp pain.

• Eye pain.

• Neck pain.

• One eye with a droopy lid and small pupil (partial Horner syndrome).

• Weakness or numbness on one side of your body.

• Having trouble understanding speech or speaking.

• Pulsing sound in an ear.

• Trouble swallowing.

• Abnormal or lost sense of taste.

How is carotid dissection diagnosed?

Your doctor will ask about your symptoms and health history. They may also ask about recent injuries and activities. During a physical exam, your doctor may check your face and eyes, strength, reflexes, and sensation.

You may have tests to check for types of headaches, nerve disorders, bleeding of the brain, and stroke. You may also have imaging tests of the carotid arteries. These are done to look at blood flow. Tests you may have include:

• MRI of the brain and neck.

• Magnetic resonance angiography of the brain and neck.

• Cranial CT.

• Cranial computed tomography angiography.

• Carotid Doppler and ultrasound.

If you have a health condition that raises your risk of a dissection, you may need more tests. You may need to see a neurologist, vascular surgeon, or neurosurgeon. One of these doctors can make the diagnosis and treat your dissection.

How is carotid dissection treated?

You will likely need to go to the hospital to check on your health condition and for initial treatment. Treatment choices depend on your age, overall health, and symptoms. They may include:

• Clot-buster medicine (thrombolytic), if you had a stroke.

• Heparin to prevent blood clots.

• I.V. (intravenous) fluids.

• Blood pressure medicine.

• Insulin or glucose to control your blood sugar.

• Pain medicine, such as acetaminophen, ibuprofen, or naproxen.

• Antiplatelet medicine, such as aspirin.

• Anticoagulant medicine, such as warfarin.

You may need to take antiplatelet or anticoagulant medicine for 3 to 6 months. At that point, you may need imaging tests to see how your artery is healing.

If you keep having carotid dissection, your doctor may advise 1 of these:

• Putting a tube (stent) into the artery

• Having surgery to fix or bypass the artery

When should I contact my doctor?

Contact your doctor if your symptoms get worse, or you have new symptoms.

Call 911

A carotid dissection can cause problems with blood flow to your brain or eyes. This can cause a TIA, stroke, or 1-sided blindness. All of these are medical emergencies. Call 911 if you think you might be having a stroke or TIA.

B.E. F.A.S.T. is an easy way to remember the signs of a stroke. When you see these signs, you will know that you need to call 911 fast.

B.E. F.A.S.T. stands for:

• B is for balance. Sudden loss of balance or coordination.

• E is for eyes. Vision changes in 1 or both eyes.

• F is for face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

• A is for arm weakness. One arm is weak or numb. When the person lifts both arms at the same time, 1 arm may drift downward.

• S is for speech difficulty. You may notice slurred speech or difficulty speaking. The person can't repeat a simple sentence correctly when asked.

• T is for time to dial 911. If someone shows any of these symptoms, even if they go away, call 911 right away. Make a note of the time the symptoms first appeared.

Key points about carotid dissection

• A carotid dissection is a tear in the inner layer of the wall of a carotid artery. This causes bleeding into the artery wall.

• It can be due to injury. Or it may occur with no known cause.

• Imaging tests can help rule out other conditions that can cause similar symptoms.

• You may need to take medicines for 3 to 6 months or more.

• If you keep having carotid dissections, you may need a tube (stent) placed in the artery. Or you may need surgery called a bypass.

Next steps

Tips to help you get the most from a visit to your doctor:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your doctor tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your doctor if you have questions, especially after office hours or on weekends.