Spontaneous intracranial internal carotid artery dissection: report of 10 patients.
BACKGROUND
Spontaneous intracranial internal carotid artery (ICA) dissection is an uncommon cause of cerebral infarction, particularly when compared with the dissection of the ICA's cervical portion. Most reports describe extensive strokes with very high mortality rates.


OBJECTIVE
To report the clinical and radiological findings of 10 patients with spontaneous intracranial ICA dissection.


METHODS
Ten patients (5 women) were included with ages ranging from 15 to 59 years (mean age, 28 years).


RESULTS
Nine patients had a stroke (1 had an associated subarachnoid hemorrhage), whereas 1 patient had only transient ischemic attacks. Severe retro-orbital or temporal headache followed by contralateral hemiparesis was the most common initial clinical symptom. No patient had vascular risk factors or a history of neck or head trauma. Stenosis of the supraclinoid portion of the ICA occurred in 8 patients, with extension to the middle cerebral artery or anterior cerebral artery in 2 patients each. Aneurysm formation in the ipsilateral anterior cerebral artery was seen in 1 patient. Two patients had a total occlusion of the supraclinoid portion of the ICA. All patients did well, with no (n = 3), mild (n = 4), or moderate (n = 3) disability on the Modified Rankin Scale during a 3-month follow-up period.


CONCLUSIONS
Spontaneous intracranial ICA dissection can cause ischemic stroke with or without subarachnoid hemorrhage and should be considered in the differential diagnosis of intracranial ICA stenosis or occlusion, especially in young patients. Some patients survive with few or moderate deficits.
Chaves
Claudia
C
Department of Neurology, Lahey Clinic, Burlington, MA 01805, USA. claudia.j.chaves@lahey.org
Estol
Conrado
C
Esnaola
Maria M
MM
Gorson
Kenneth
K
O'Donoghue
Margaret
M
De Witt
L Dana
LD
Caplan
Louis R
LR
D000293:Adolescent; D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis* / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged