This is the left carotid artery angiography of a patient who
from persistent headache following a road traffic accident.
a. What does the angiography show?
There is a left internal carotid artery dissection with the
of a false aneurysm.
Hyperextension of the neck is a common mechanism of injury causing
stretching of the internal carotid artery over the transverse processes
of the cervical vertebrae. Other traumatic causes include chiropractic
manipulation, attempted strangulation, or cerebral angiography.
b. What ocular signs and symptoms may be present?
The most common symptom is ipsilateral headache, usually located
the orbital / periorbital area. In addition, there may be a severe
pain over the carotid artery in the neck (carotidynia). Patients may also
get an incomplete Horner's syndrome: drooping of the eyelid (ptosis) and
small pupils (miosis). The patient may hear bruits (murmur in a vessel
caused by flowing blood). Stroke-like or ischemic symptoms are less common.
c. How would you manage this condition?
The mainstay of treatment is medical and aiming to prevent
This consists of anticoagulation and involves the use of heparin initially
and then with warfarin for about 8-12 weeks.
Repeat angiography may be needed before stopping treatment to ensure
that the vessel has healed.
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