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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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