A Spontaneous Internal Carotid Artery Dissection Presenting With Headache and Miosis

Doppler Ultrasound. This is another imaging modality used to detect ICAD—one that is noninvasive, less expensive, requires no contrast material, and is widely available. Limitations of Doppler ultrasound include the inability to scan the distal ICA and a lower sensitivity in detecting dissections that cause low-grade stenosis.² It is more commonly used for follow-up monitoring of dissections.

Management

There are several options for managing ICAD. In patients with unstable lesions, progressing neurological deficit, or further strokes, endovascular stenting has been shown to have a technical success rate of 99% and a procedural complication rate of 1.3%.¹² Similarly, if the patient exhibits symptoms of cerebral ischemia, severe narrowing of the arterial lumen, or an unstable plaque, IV heparin is frequently used, followed by warfarin.¹³ However, since the majority of carotid and vertebral artery dissections heal spontaneously,¹⁴ antithrombotic therapies, including aspirin, clopidogrel or warfarin, are often prescribed to prevent thromboembolic complications.

Conclusion

Diagnosing ICAD requires knowledge of the typical history and presenting features of the disease. Careful attention to the ocular examination must be undertaken in any patient presenting with headache or face or neck pain, because the findings can be subtle. In a patient in whom ICAD is suspected, imaging with CTA or MRI/MRA should be performed. Early consultation with vascular surgery services  can help determine the most appropriate treatment strategy.