Carotid artery dissection is a serious but often under-recognized cause of stroke, especially in younger patients. Early diagnosis and treatment can make a significant difference in patient outcomes. This condition occurs when a tear forms in the inner lining of the carotid artery, leading to reduced blood flow to the brain. Symptoms can be subtle like neck pain, headache, or even temporary vision loss so timely evaluation is crucial.
Understanding Carotid Artery Dissection: A Rare but Serious Cause of Stroke
Although uncommon, carotid artery dissection (CAD) is a serious condition and is one cause of stroke. It is estimated that 2.5 to 3 individuals out of 100,000 experience CAD sometime in their lifetime. Of those, there is less than a 5% mortality rate.
CAD is a tear in one of the two carotid arteries located in the neck, which provide the brain's blood supply. The condition can be genetic and is of higher risk due to hypertension, high cholesterol, or high triglycerides.
What is Carotid Artery Dissection?
Everyone has two carotid arteries, one on each side of the neck. Both are responsible for carrying blood to the brain. A carotid artery dissection can restrict blood flow, cause clot formation, and potentially a stroke.
Common Causes and Risk Factors
The most common cause of carotid artery dissection is hyperextension of the neck when the head moves forward and then snaps backward. This can occur through a whiplash during an automobile accident, or another form of accident, including when playing sports.
The tendency for possible CAD can be genetic through connective disease disorders, including Marfan syndrome or Ehlers-Danlos. High blood pressure, high cholesterol, a recent infection, or a cough can contribute to risk factors.
Unlike most other causes of stroke, carotid artery dissection is more likely to occur in young adults under the age of 50.
Common Questions About Carotid Artery Dissection (CAD)
What is a carotid artery dissection?
A carotid artery dissection (CAD) occurs when a tear develops in the inner lining of one of the carotid arteries, which supply blood to the brain. Blood can enter the wall of the artery, causing it to narrow or form a clot, which may reduce blood flow to the brain and increase the risk of a transient ischaemic attack (TIA) or stroke.
What are the symptoms of a carotid artery dissection?
Symptoms vary but commonly include sudden neck pain, headache, facial pain or eye pain on one side. Some people may also develop drooping of the eyelid (Horner syndrome), weakness, numbness, difficulty speaking, vision changes or other stroke symptoms. Prompt medical assessment is essential if these symptoms occur.
What causes a carotid artery dissection?
A carotid artery dissection may occur after minor trauma, sudden neck movements, sports injuries or road traffic accidents. However, many cases develop spontaneously without an obvious cause. Certain inherited connective tissue disorders and underlying vascular conditions may also increase the risk.
How is a carotid artery dissection diagnosed?
Diagnosis usually involves CT angiography (CTA), MR angiography (MRA), MRI or duplex ultrasound. In selected cases, cerebral angiography may be recommended to better define the anatomy or assist with treatment planning.
Can carotid artery dissection be treated without surgery?
Yes. Many patients are successfully managed with medications that reduce the risk of blood clot formation while the artery heals. For selected patients with significant narrowing, persistent symptoms or stroke despite medical therapy, minimally invasive endovascular procedures such as carotid artery stenting may be considered.
Signs and Symptoms of CAD
Some common symptoms of carotid artery dissection are like other stroke symptoms and include:
- Headache
- Eye pain or sensitivity
- Scalp pain
- Neck pain
- A droopy eyelid
- Hearing a pulsing sound in the ear
- Weakness or numbness on one side of the body
- Difficulty swallowing
Testing for a Possible CAD Diagnosis
Many general practitioners have basic knowledge and experience in diagnosing and treating CAD. If you or a loved one are experiencing signs or symptoms of CAD or a stroke, you should be seen by a doctor for a quick and accurate diagnosis. Dr. Manish Taneja of the Supreme Vascular and Interventional Clinic in Singapore is an experienced stroke specialist. Our clinic has proper stroke screening equipment, including MRIs, CT scans, and Doppler ultrasounds.
CAD and Stroke Treatment Options
CAD and stroke management treatment options differ from one individual to another depending upon age, other health conditions, and to aid in stroke prevention. In some cases of CAD without stroke, time and rest may be all that is required. But in other cases, and if a stroke has occurred, some treatment recommendations may include:
- Blood pressure medication
- Blood sugar medication including insulin
- Blood thinners including anticoagulants
- Aspirin
- Other over-the-counter pain medication
- Surgery or Carotid stenting
Recovery and Long-term Outlook
The timeline for CAD recovery can vary, especially for stroke prevention or stroke management. Most carotid artery dissections will heal with proper management and time. Appropriate lifestyle changes should be made, such as quitting smoking, limiting alcohol use, losing weight, eating a healthy diet, and adhering to an appropriate exercise regime.
It is important to follow your doctor's advice along with routine monitoring and follow-up imaging.
Why Choose a Specialized Stroke Clinic in Singapore?
The key to proper health management following CAD and stroke is continuing with your physician, who specializes in stroke. As a stroke specialist in Singapore, Dr. Manish Taneja focuses on the latest advanced imaging techniques and endovascular therapies, offering personalized treatment for his patients from the onset of emergency treatment through follow-up and long-term recovery.
When to Consider a Vascular Specialist Assessment in Singapore
Carotid artery dissection is an important cause of stroke, particularly in younger and middle-aged adults. Early diagnosis and specialist assessment help reduce the risk of further neurological complications and guide appropriate treatment.
Consider seeking a specialist assessment if you:
- Develop sudden neck pain, facial pain or headache together with neurological symptoms
- Experience temporary weakness, numbness, difficulty speaking or vision changes suggestive of a transient ischaemic attack (TIA)
- Have abnormal findings involving the carotid arteries on ultrasound, CT, CTA, MRI or MRA
- Have experienced a stroke that may be related to carotid artery dissection
- Have a history of connective tissue disorders, previous arterial dissections or unexplained vascular conditions
- Require follow-up imaging after treatment for a carotid artery dissection
- Would like a second opinion regarding medical therapy, carotid artery stenting or long-term monitoring
A specialist consultation includes reviewing your symptoms, neurological examination, vascular imaging and overall stroke risk. Based on these findings, your specialist will recommend an individualised management plan, which may include medication, surveillance imaging or minimally invasive endovascular treatment where appropriate.
Seek emergency medical attention immediately if you experience sudden weakness, numbness, facial drooping, difficulty speaking, sudden vision loss, confusion or a severe, unexplained headache. These symptoms may indicate a stroke and require immediate emergency treatment.
When to Seek Help
Stroke symptoms are signs of an emergency. To recognize signs of a stroke, think FAST.
- Face drooping on one side
- Arm weakness
- Slurred speech
- Time to call emergency responders
If you or a family member is experiencing signs of a stroke such as unusual head or neck pain, especially after trauma, call 9-9-5. Whether you require a proper evaluation, have concerns, or are looking for a long-term stroke-management plan, contact Dr. Manish Taneja at our specialized stroke clinic in Singapore today.
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To dive deeper into the types of neurointerventional treatments, head over to our clinic’s blog.
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We've Got You Covered for Specialized Stroke Screening, Prevention, and Management
Imagine heart attacks where the blood flow to your heart is blocked. Similarly, a stroke occurs when the blood flow to your brain is interrupted becoming a "brain attack". When blood supply does not reach a certain part, brain cells begin to die. Different types of stroke include ischemic strokes (blockage of blood vessel due to blood clot) or a mini stroke, a TIA (transient ischemic attack), with no permanent damage yet serious. Stroke also occurs when a blood vessel in the brain pops causing bleeding in the brain.
When a stroke occurs, the symptoms of stroke depend on how blood flow to the brain is affected. Individuals at high risk and even higher risk (family history) often have high blood pressure, atrial fibrillation, or another risk factor for stroke, all of which increase the risk of stroke. Disrupted blood flow can even damage the blood vessel in the brain and affect one side of the body. Having a stroke doesn’t mean it has to lead to permanent disabilities. Recognizing early warning signs is essential to reduce the risk, and in some cases, procedures such as carotid endarterectomy may help increase the blood vessel in the brain and restore healthy circulation.
Certain areas of the brain can be affected by stroke and some symptoms of a stroke including cardiovascular disease, diabetes, and high blood sugar levels increase the risk of stroke whereas an active lifestyle or controlling high cholesterol reduces the risk. How well do you know stroke? Find tips to prevent and manage stroke, the differences in stroke screening tests, and the newer technology and treatments available. Come in for an easy consultation and further evaluation with our stroke specialist in Singapore at the Supreme Vascular and Interventional Clinic.
Supreme Vascular and Interventional Stroke Programs
Neurointerventional / Stroke Treatments
The Supreme Vascular and Interventional Clinic is your "go-to" facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our stroke specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.