Carotid Artery Dissection

A real headache

Step 1: View clinicals

A 32 year old man presents with a progressively worsening left sided throbbing headache for 1 week. He did not experience fever, nausea, photophobia, phonophobia or diurnal symptoms. There was no associated limb weakness or sensory symptoms. His medical history is unremarkable, with no history of chronic headaches.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 7,000/mm3 N: 71%, L: 25% Hb: 13.3 g/dl PCV: 40 % Platelets: 400,000/mm3

CT Brain

The CT scan of the brain shows an area of low attenuation in the left parietal lobe. There is no evidence of midline shift and the ventricles appear normal.

MR Angiography

MRA demonstrates stenosis of the left internal carotid artery (L/ICA) just above the carotid bifurcation. A concomitant T1 weighted axial MRI demonstrates a semilunar hyperintense signal suggestive of an intramural hematoma in the stenosed region.

ECG

The ECG appears normal.


Step 3: Select appropriate management

Heparin
Warfarin
Statins
Carotid graft replacement


Score: ★★☆