title: "Phacing" a New Cause of Carotid Artery Dissection.
abstract: BACKGROUND
  Cervical arterial dissection (CAD) is a frequent and preventable cause of ischemic stroke in young patients. Several arguments suggest that genetic and developmental disorders could play an important role as part of a multifactorial predisposition of sporadic CAD.We present 2 cases of young patients with CAD in association with cutaneous lesions and nonatherosclerotic multivessel arteriopathy.
  
  
  METHODS
  Our first patient was a 17-year-old white girl with sudden onset of weakness in her right upper limb. A magnetic resonance angiogram showed a severe stenosis along the extracranial and intracranial segments of the left internal carotid artery and the left middle cerebral artery. A complete ultrasound study confirmed the stenoses with characteristics suggestive of dissection.Our second patient was a 7-year old white girl with a past history of left middle cerebral artery ischemic stroke. During the follow-up, an ultrasonographical examination discovered an asymptomatic dissection of the right internal carotid artery.Both patients reported a history of large unilateral hemangiomas; in the first case a coloboma of the left optic disc and an aortic aneurysm were also present. These findings were suggestive of PHACE-a neurocutaneous developmental syndrome associated with constitutional arteriopathy of the major cerebral vessels.
  
  
  CONCLUSIONS
  Noteworthy, among vascular abnormalities of PHACE, CADs have never been reported before. Our 2 cases suggest that CAD is an underecognized cerebrovascular manifestation of PHACE and it should be searched for in these patients. Ultrasound, being noninvasive and portable, is a useful tool for the assessment and follow-up of these patients.
authors.affiliation: Departments of *Neurological Sciences †Neurological Sciences, Neuroradiology Unit ‡Pediatric Neurology §Neuroscience, University of Padua, School of Medicine, Padova, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Kulyk
authors.forename: Filippo
authors.initials: F
authors.lastname: Farina
authors.forename: Anna
authors.initials: A
authors.lastname: Palmieri
authors.forename: Federica
authors.initials: F
authors.lastname: Viaro
authors.forename: Francesco
authors.initials: F
authors.lastname: Causin
authors.forename: Anna M
authors.initials: AM
authors.lastname: Laverda
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
mesh_terms: D000293:Adolescent; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D014463:Ultrasonography