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Julien Bogousslavsky, MD
Department of Neurology Centre Hospitalier Vaudois Lausanne, Switzerland

Arch Neurol. 1988;45(2):138.

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In Reply.

—Dr Kushner is correct that the natural prognosis of carotid dissection is poorly known. This is due to the fact that it can yield extremely varied disturbances, from isolated mild headaches or Horner's syndrome to rapidly lethal stroke; conditions in which angiography is unlikely to be performed, so that carotid dissection may not be recognized. For this reason, we have chosen to focus our study on a particular subgroup of patients (those with stroke and a picture of carotid occlusion during the acute phase), in which a selection bias is less likely to occur, because of our referral pattern that was made explicit in our article. Of course, we did not extend our conclusions to dissection with minor symptoms, such as transient ischemic attacks or headaches; this has already been emphasized in the article. Our findings on prognosis are less optimistic than Dr Kushner and we would have liked, but . . . [Full Text PDF of this Article]

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