DISSECTION OF THE ICA WITH ACUTE INFARCT.
- Dissection of the internal carotid artery is a common cause of stroke in young adults and middle-aged patients
- The vast majority of ICA dissections are extracranial. Although some cases can be attributed to neck trauma or an underlying fibrodysplastic syndrome, most ICA dissections are spontaneous.
- Most patients with internal carotid artery dissection present with headache and signs of acute cerebral ischemia.A distinct minority of patients with internal carotid artery dissection may present with headacheand ipsilateral lower cranial nerve palsy or Horner's syndrome. Hence emergency physicians should perform a careful cranial nerve examination when evaluating patients with a complaint of headache.
- Early anticoagulation may prevent subsequent TIA and stroke, although this widely used treatment has not been prospectively validated.