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Stroke Following Carotid Dissection - Stroke from Carotid Dissection
- Overview, Causes, & Risk Factors
- Symptoms & Signs
- Diagnosis & Tests
- Prevention & Expectations
- Treatment & Monitoring
- Attribution
Overview, Causes, & Risk Factors
A stroke is the death of brain tissue that occurs when the brain does not get enough blood and oxygen. A stroke from carotid dissection occurs when one of the carotid arteries in the neck is torn, or dissected.
What is going on in the body?
A carotid dissection occurs when the layers of the wall of the carotid artery break down. Carotid dissection is sometimes caused by an injury to the head or neck.
The carotid dissection causes a blockage of the artery and impairs blood flow to the brain. The brain cells then die from lack of oxygen. In turn, the blood also damages the brain cells. The products released when cells die cause swelling in the brain. Since the skull doesn't allow much room for expansion, this swelling can damage the brain tissue even further.
What are the causes and risks of the condition?
Carotid dissection can be brought on by:
The person's risk of stroke from carotid dissection is increased if other risk factors for stroke are also present.
The American Heart Association has recently issued guidelines for stroke prevention. The guidelines discuss risk factors for stroke in 3 categories: nonmodifiable, well-documented modifiable, and less well-documented or potentially modifiable.
The nonmodifiable factors are ones that cannot be changed by the individual and include:
Well-documented modifiable risk factors are those that can be changed by the individual in conjunction with his or her healthcare provider. These factors are linked to stroke by strong research findings, and there is documented proof that changing the risk factor lowers a person's risk of stroke. These factors include:
Less well-documented or potentially modifiable risk factors for stroke are those that have less proof of either a link to stroke or the impact of modifying the risk factor. These factors include:
Several recent studies have identified factors that seem to increase or decrease the risk of stroke in particular groups of people. These studies, which warrant further investigation, include these findings:
Symptoms & Signs
What are the signs and symptoms of the condition?
Stroke from carotid dissection can cause different signs and symptoms, depending on the area of the brain that is damaged. Signs or symptoms may include:
Diagnosis & Tests
How is the condition diagnosed?
A magnetic resonance angiogram, which involves injecting a dye into an artery or blood vessel for better viewing, may be ordered to detect carotid dissection. In this test, the carotid artery of a person with carotid dissection will show what is called a string sign. This is described as an elongated, irregular, narrow column of dye in the artery.
Cranial MRIs and cranial CT scans may be ordered to show the type, size, and location of the stroke.
Prevention & Expectations
What can be done to prevent the condition?
Carotid dissection can be prevented by avoiding any trauma to the head or neck. It's important to use seat belts while driving. Head injuries and neck injuries can be minimized by following sports safety guidelines for children, adolescents, and adults.
People can also lower their risk of stroke from carotid dissection by addressing other risk factors for stroke. The American Heart Association guidelines for stroke prevention address both modifiable and less well-documented or potentially modifiable risk factors.
Measures to reduce the modifiable risk of high blood pressure include:
Other measures to reduce an individual's modifiable risk factors for stroke may include:
Measures to reduce less well-documented or potentially modifiable risks for stroke may include:
Some people have early warning signs that they are at risk for strokes. The most common warning sign is what is known as a transient ischemic attack, or TIA. This is a type of reversible stroke that often goes away after a few minutes. These people can often get treatment that will prevent a stroke in the future. For instance, people may be advised to take aspirin or have carotid artery surgery to correct a blockage in a neck artery.
What are the long-term effects of the condition?
Strokes can cause death or permanent disability. Though many people recover some function in the first several months after a stroke, others show no improvement. Some people have several small strokes over time and slowly get worse with each one.
What are the risks to others?
Strokes are not contagious and pose no risk to others.
Treatment & Monitoring
What are the treatments for the condition?
A person with a stroke from carotid dissection is usually treated immediately with the blood thinner heparin administered through the vein. After heparin, another blood-thinning medication, warfarin, is taken orally.
If someone has the early warning signs of stroke, the emergency medical system should be contacted immediately. These signs include a sudden onset of:
Supportive therapy may also be needed with some strokes. This may include an artificial breathing machine, or ventilator, and an artificial feeding tube if the person cannot swallow.
Rehabilitation services can help to improve a person's function after a stroke. Physical therapy and other therapy, such as speech therapy or occupational therapy, may be used to maximize recovery.
What are the side effects of the treatments?
Excessive bleeding from the blood-thinning medications, or anticoagulants, is possible. People need to avoid activity that may cause bruises or cuts, such as rough sports or working with sharp tools.
What happens after treatment for the condition?
After the person is stable, treatment of the risk factors for stroke, as well as the cause of the stroke, is important to prevent further strokes. For instance, stopping smoking and controlling high blood pressure, diabetes, and high cholesterol are advised for most people.
Blood thinners such as warfarin may be discontinued in several months or a year depending upon the results of a repeat imaging test. The healthcare provider may discontinue these medications if the angiogram shows that the opening of the carotid artery is unblocked so that enough blood can flow through the artery. This is known as a patent artery and is considered to be at least 50% of normal diameter with a smooth wall.
Many people need assistance of one form or another after a stroke. This may range from using a walking cane to needing 24-hour-a-day skilled nursing care. Ongoing therapy to improve function is usually advised for at least 6 months if the person is able.
How is the condition monitored?
If an individual takes blood thinners, blood tests are normally done to assure the correct dose. These tests let a healthcare provider know if the person's blood is too "thin" or too "thick," which may require a dosage adjustment. Any new or worsening symptoms should be reported to the healthcare provider.
Attribution
Author:Tamara Miller, MD
Date Written:
Editor:Ballenberg, Sally, BS
Edit Date:01/31/01
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:07/15/01