What are the symptoms of cervical artery dissection?

Sometimes a stroke is the first sign of cervical artery dissection and emergency treatment is required. More commonly, symptoms develop over a period of hours or days, even in patients who have traumatic injuries. Symptoms are general rather than specific and include headache, neck and face pain (especially pain around the eyes), vision disturbances such as double vision or a droopy eyelid, a pulsatile “whooshing” sound in one of the ears, known as pulsatile tinnitus, or a sudden decrease in sense of taste and/or weakness on one side of the body.

Stroke can develop hours, days or even a week after these symptoms begin. This is the most serious risk of cervical artery dissection.

How is cervical artery dissection diagnosed?

When a patient comes to the doctor's office or the emergency room with any of the symptoms described above, the doctor may suspect cervical artery dissection. To accurately diagnose this condition, the doctor can choose from several different imaging technologies to see how well blood is flowing through the carotid and vertebral arteries and if there is a tear present.

Helical computed tomography angiography (CTA) is becoming the gold standard for use in patients with symptoms of cervical artery dissection. This is a noninvasive type of imaging that uses computed tomography (CT) technology and a contrast dye to provide an accurate, three-dimensional picture of the arteries on a computer screen.

Magnetic resonance angiography (MRA) is another, very accurate, noninvasive imaging technique that can be used for diagnosing cervical artery dissection. MRA uses a magnetic field and radio waves to provide pictures of the carotid and vertebral arteries and can be performed without or with a special type of contrast material.

In addition to blood flow, these technologies can show changes in the dimension of the carotid and vertebral arteries, blood in the wall of the artery, whether or not there is a pseudoaneurysm, and changes to structures surrounding the blood vessel. CTA is especially useful because it can create cross-sectional images of the blood vessel that will show separation of the layers of the vessel wall that is characteristic of dissection. These studies can also assess the brain and determine if there has been damage to brain tissue as a result of the dissection.

Doppler ultrasonography (DUS) is gaining popularity as a useful tool in identifying cervical artery dissection. This technology is now widely available in the hospital setting. Doppler ultrasound can detect abnormal blood flow in a dissected carotid artery. DUS has the advantages of being fast, noninvasive and easy to use at the patient's bedside. In some situations, however, the dissection may be too high up in the neck or may not be well seen with ultrasound, such as for the vertebral arteries.

As these non-invasive imaging technologies have developed and improved, the use of conventional angiography for diagnosing cervical artery dissection has decreased.

Conventional angiography uses a contrast dye and X-ray to image the blood vessels. It may not beas accurate as the non-invasive imaging technologies, is invasive and has a 0.5 percent risk of complications, including a procedure-related stroke.

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