Severe Ischemic Stroke Due To Progression of Cervical Carotid Artery Dissection - Severe Ischemic Stroke Due To Progression of Cervical Carotid Artery Dissection - Open Access Pub

Spontaneous dissection of the cervical segment of the internal carotid artery (CS-ICA) is uncommon but not rare. A 43-year-old man suddenly developed complete right hemiparesis with motor aphasia. 3 weeks after the initial symptom onset. Magnetic resonance imaging showed enlargement of an intramural hematoma at the cervical carotid artery; it severely compressed and completely occluded the arterial lumen. Diffuse ischemia was observed in the area of the left middle cerebral artery (MCA) immediately after onset and he underwent emergency left superficial temporal artery-MCA double bypass within 6 hours. There was no fatal deterioration and his neurological deficit was resolved. We discuss our treatment of spontaneous dissection of the CS-ICA to prevent ischemic damage. DOI10.14302/issn.2470-5020.jnrt-17-1733 Earlier population-based studies on the incidence cervical internal carotid artery (ICA) dissection revealed an annual incidence rate of 2.6 - 2.9 per 100,000 individuals. Cervical ICA dissection is among the most common contributors to stroke in young and middle-aged adults (under 45 years) without vascular risk factors. They are less likely to have cerebrovascular atherosclerosis; approximately 2% of overall ischemic stroke is seen in that population.1, 2, 3, 4, 5 Vertebral artery dissection (VAD) tends to be less common than cervical ICA dissection in Europe and America, however, reliable epidemiologic data are not available.6, 7, 8 According to a Japanese study, the most common site of dissection in the Japanese was the intracranial vertebro-basilar artery;9 dissection of the cervical segment of the internal carotid artery (CS-ICA) is rarely encountered. In more than 85% of the dissected vessels, ICA stenosis resolved or improved substantially3, 10, 11 and 92% of patients had a good treatment outcome.12 As most patients tend to do well regardless of the type of treatment,8, 10, 13 identification of the optimal treatment in patients with ICA dissection is difficult.6, 14, 15 We encountered a 43-year-old Japanese male with sudden-onset severe ischemic stroke attributable to the progression of spontaneous dissection of the CS-ICA that had been diagnosed 3 weeks earlier. Prior written consent for the publication of our findings was obtained from the patient. This 43-year-old Japanese male presented with right hand dysesthesia. He has not recognized his neck pain and Horner’s syndrome( oculosympathetic palsy). Magnetic resonance imaging(MRI) performed on a 3T TX scanner (Philips Achieva, The Netherlands) demonstrated dissection of the left cervical