Spontaneous dissection of the internal carotid artery in 68 patients.
OBJECTIVES: Our purpose was to know more about the symptoms and clinical and radiological outcome of spontaneous dissections of the internal carotid artery in a retrospective study of 68 patients aged 20 to 71 (mean 46). METHODS: The diagnosis of dissection was based on angiographic findings. Nine percent of patients had minor symptoms such as a subjective bruit or painful Horner's syndrome, without an ischaemic event. Cerebral ischaemia was present in 90% of cases and occurred within a month of the initial event in all cases but one and was the first symptom in 53% of cases. RESULTS: Magnetic resonance imaging performed in 21 cases showed haemorrhage in the vessel wall. Resolution of the angiographic appearances occurred in 65% of cases after 3 months. In cases of stroke, more than half of the patients had poor functional outcome, factors conveying poor prognosis were massive stroke, embolic mechanism and lack of local recanalization. CONCLUSION: Spontaneous dissection of the internal carotid artery is not a rare cause of cerebral ischaemia and can present with minor symptoms without an ischaemic event. Doppler ultrasonography and magnetic resonance imagery are helpful in diagnosis and follow-up.