Carotid Artery Dissection: Signs of a Tear in Your Neck Blood Vessel

Carotid Artery Dissection: Signs of a Tear in Your Neck Blood Vessel

The carotid arteries are the primary highways carrying oxygenated blood from the heart through the neck to the brain. A carotid artery dissection occurs when a tear develops in the innermost layer (the intima) of the arterial wall.

Blood under high pressure seeps into the layers of the artery wall, creating a blood clot within the wall itself (intramural hematoma). This can cause the artery to narrow, block blood flow entirely, or form a bulging pseudoaneurysm. Carotid artery dissection is one of the leading causes of ischemic stroke in young and middle-aged adults.

Common Causes of Carotid Dissection

Dissections can develop spontaneously or follow mechanical force to the neck:

• Blunt Head or Neck Trauma: Motor vehicle collisions, sports injuries, or sudden violent neck hyperextension/rotation.
• Spontaneous Tears: Occurring in individuals with underlying connective tissue weakness (such as Ehlers-Danlos syndrome, Marfan syndrome, or fibromuscular dysplasia) during everyday activities like heavy lifting, coughing, or intense exercise.

Recognizing the Warning Signs

Symptoms of carotid dissection often develop in two distinct stages: local warning signs followed by brain ischemia.

Local Warning Signs (Hours to Days Before Stroke)

• Unilateral Neck or Facial Pain: Sharp, persistent pain on one side of the neck, jaw, or behind one eye.
• Partial Horner’s Syndrome: Drooping of one eyelid (ptosis) and a constricted pupil (miosis) on the same side as the neck pain, caused by nerve compression along the carotid sheath.
• Pulsatile Tinnitus: A WHOOSHING sound in one ear synchronized with your heartbeat.

Ischemic Symptoms (Emergency)

If the blood clot reduces cerebral blood flow or breaks free to travel into the brain, it triggers a Transient Ischemic Attack (TIA) or Acute Stroke:

• Sudden weakness or numbness on one side of the body.
• Difficulty speaking or understanding language.
• Sudden loss of vision in one eye (“amaurosis fugax”).

Diagnosis and Emergency Treatment

Carotid artery dissection requires rapid evaluation using CT Angiography (CTA) or Magnetic Resonance Angiography (MRA) to visualize the tear and vessel narrowing.

Treatment focuses on preventing stroke. Many dissections heal naturally over time with antiplatelet or anticoagulant medications. However, if a patient experiences persistent blood flow restriction or an expanding pseudoaneurysm, neuroendovascular stenting is performed to expand the vessel lumen, seal the tear, and restore clear blood flow to the brain.

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