16857 Cervical Carotid Or Vertebral Artery Dissection

Overview

A neck artery dissection is a tear in the inner lining of one of the large blood vessels in your neck that carry blood to your brain. This tear can cause blood to clot where it shouldn't, which may block blood flow and cause a stroke. It is a serious condition, but with prompt care, most people recover well.

It is rare. Each year, about 2 to 3 people in every 100,000 are diagnosed with a neck artery dissection. But among young and middle-aged adults with stroke, it is one of the most common causes.

It can happen to anyone, but it is most often seen in adults under 50. It occurs slightly more often in men than in women. People with high blood pressure, migraine, or certain connective tissue diseases have a higher risk.

Symptoms

Common symptoms

• headache, often on one side of the head or neck
• neck pain or stiffness
• a whooshing or pulsing sound in one ear
• pain around the eye or face
• blurred or double vision
• dizziness or a spinning feeling
• difficulty speaking or understanding words
• weakness or numbness on one side of the body
• drooping on one side of the face

Symptoms in children

• headaches that are unusual or severe
• vomiting
• trouble walking or keeping balance
• weakness in an arm or leg
• seizures in some cases

Symptoms in older adults

• similar symptoms to younger people
• confusion or trouble thinking clearly
• memory problems
• less obvious neck pain, so the cause may be harder to spot

Causes

Main causes

• A tear in the artery lining, which can be caused by a neck injury, such as in a car accident, a fall, or a sudden twist
• Certain neck movements, including forceful chiropractic adjustment or a sudden turn of the head
• Even intense physical effort, coughing, sneezing, or vomiting can sometimes trigger a tear
• Sometimes the tear happens without any clear cause

Risk factors

• high blood pressure
• migraine
• connective tissue disorders, such as Ehlers-Danlos syndrome
• smoking
• high cholesterol
• illegal stimulant drugs like cocaine
• a family history of artery dissection

When to see a doctor

See a doctor urgently if:

• If you have any sudden stroke-like symptoms, call your local emergency number immediately and ask for an ambulance. Do not wait.
• Also seek urgent help if you have a sudden, severe headache or sudden severe neck pain.

Book a routine appointment if:

• If you have unexplained neck pain with headaches that last for several days or keep coming back, make an appointment with your doctor.
• If you have a whooshing sound in your ear that does not go away, see your doctor.

Diagnosis

A doctor will ask about your symptoms and recent injuries, and do a physical exam. They will check your strength, balance, reflexes, and the pulses in your neck. They may also listen to the arteries with a stethoscope.

Tests that may be done

• MRI or CT scan of the head and neck
• CT angiography (a CT scan with dye to see blood vessels)
• ultrasound of the neck arteries
• occasionally a conventional angiogram (injecting dye directly into the artery)

What to expect at your appointment

The imaging tests are usually painless and take about 30 to 60 minutes. You will lie still on a scanning table. If a dissection is found, your doctor will explain the results and start treatment right away. In many cases, you will be admitted to the hospital for observation and treatment.

Treatment

The main goal of treatment is to prevent a stroke while the artery heals. Most people are given medicines that make it harder for blood to clot. You may need to keep taking these medicines for several months or longer. You may also be admitted to the hospital for close monitoring.

Self-care at home

• Rest and avoid strenuous activities like heavy lifting and contact sports until your doctor says it is safe
• Keep your blood pressure in a healthy range, if you have high blood pressure
• Do not smoke or use illegal drugs
• Follow your doctor's advice about returning to work and daily activities
• Attend all follow-up appointments

Medical treatments

Doctors often prescribe medicines called antiplatelet agents or anticoagulants, which help prevent blood clots from forming. The choice depends on your particular situation and any other health conditions you have. You may be treated in the hospital or at home, depending on how severe the dissection is. Always take your medicines exactly as prescribed and discuss any concerns with your doctor.

When is surgery considered?

Surgery or a procedure to place a small tube (stent) inside the artery is rarely needed. It may be considered if the artery is severely blocked, if there is bleeding around the brain, or if the dissection does not heal despite medicine.

Living with this condition

Recovery takes time, often several weeks to months. You may feel tired and need rest at first. Your doctor will guide you on when you can return to driving, work, and exercise. Most people can return to a normal life, though some may need ongoing rehabilitation, such as physical or speech therapy.

Lifestyle tips

• Avoid heavy lifting or exercises that strain your neck
• Do not take part in contact sports until your doctor gives the go-ahead
• Limit alcohol and avoid smoking
• Try relaxation techniques to reduce stress
• Keep a routine and get enough sleep

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, whole grains, and lean protein. Try to limit salt, unhealthy fats, and sugary foods. Regular gentle exercise, like walking, is usually good once your doctor says it is safe. Start slowly and build up. Strenuous exercise, such as weightlifting, should wait until your artery has healed.

Mental health and emotional wellbeing

Being diagnosed with a neck artery dissection can feel scary and overwhelming. You may worry about having a stroke or about the future. It is normal to feel anxious, sad, or frustrated. These feelings often ease with time. Talk to your healthcare team about counseling if you are struggling. You can also reach out to family and friends for support.

Prevention

You cannot always prevent a neck artery dissection, but you can lower your risk of blood vessel damage by keeping your blood pressure healthy, not smoking, eating well, and staying active. If you have a condition that weakens your blood vessels, work with a specialist to manage it. Also avoid forceful, untrained neck manipulations.

Vaccines

Not applicable.

Screening programmes

Screening is not routinely recommended for the general population.

Complications

If left untreated

• A tear in the artery can cause a blood clot to form, which may block blood flow to the brain and lead to a stroke
• A stroke can cause permanent brain damage, affecting movement, speech, or thinking
• In rare cases, bleeding from the artery can press on the brain and cause serious harm

Long-term outlook

With prompt diagnosis and treatment, the outlook is generally good. The artery tear often heals within weeks to months, and the risk of stroke drops significantly after the first few weeks. Many people make a full recovery and have no lasting problems. You will need ongoing follow-up care to manage your health and reduce future risks.

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