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Spontaneous Intracranial Internal Carotid Artery Dissection
Report of 10 Patients
Claudia Chaves, MD;
Conrado Estol, MD;
Maria M. Esnaola, MD;
Kenneth Gorson, MD;
Margaret O'Donoghue, MD;
L. Dana de Witt, MD;
Louis R. Caplan, MD
Arch Neurol. 2002;59:977-981.
Background Spontaneous intracranial internal carotid artery (ICA) dissection is
an uncommon cause of cerebral infarction, particularly when compared with
the dissection of the ICA's cervical portion. Most reports describe extensive
strokes with very high mortality rates.
Objective To report the clinical and radiological findings of 10 patients with
spontaneous intracranial ICA dissection.
Methods Ten patients (5 women) were included with ages ranging from 15 to 59
years (mean age, 28 years).
Results Nine patients had a stroke (1 had an associated subarachnoid hemorrhage),
whereas 1 patient had only transient ischemic attacks. Severe retro-orbital
or temporal headache followed by contralateral hemiparesis was the most common
initial clinical symptom. No patient had vascular risk factors or a history
of neck or head trauma. Stenosis of the supraclinoid portion of the ICA occurred
in 8 patients, with extension to the middle cerebral artery or anterior cerebral
artery in 2 patients each. Aneurysm formation in the ipsilateral anterior
cerebral artery was seen in 1 patient. Two patients had a total occlusion
of the supraclinoid portion of the ICA. All patients did well, with no (n
= 3), mild (n = 4), or moderate (n = 3) disability on the Modified Rankin
Scale during a 3-month follow-up period.
Conclusions Spontaneous intracranial ICA dissection can cause ischemic stroke with
or without subarachnoid hemorrhage and should be considered in the differential
diagnosis of intracranial ICA stenosis or occlusion, especially in young patients.
Some patients survive with few or moderate deficits.
From the Department of Neurology, Lahey Clinic, Burlington, Mass (Dr
Chaves); Centro Neurologico (Dr Estol) and Hospital Frances (Dr Esnaola),
Buenos Aires, Argentina; Department of Neurology, Saint Elizabeth Medical
Center, Boston, Mass (Drs Gorson and O'Donoghue); Department of Neurology,
Newton-Wellesley Hospital, Wellesley, Mass (Dr de Witt); and Department of
Neurology, Beth Israel Deaconess Medical Center, Boston (Dr Caplan).
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Arch Neurol. 2002;59(6):1048-1050.
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