Carotid dissection

The most common clinical manifestation of ICA dissection is pain which refers to the head, eye, jaw, face or neck. Scalp tenderness may mimic GCA. Postganglionic Horner's syndrome occurs in 58 % and is often the presenting sign. 30 % experience episodes of transient monocular blindness, probably flow related rather than embolic, because of reversal of flow through the opthalmic artery. Episodes of visual loss may be precipitated by postural changes and associated with positive phenomena including sparkles and scintillations. Permanent vision loss is rare but stroke is common, even after a month or more, occurring in the retina or cerebrum, although the risk decreases markely over time. 10-15 percent develop cranial neuropathies especially of the lower cranial nerves, causing tongue weakness, dysarthria, dysphagia, and an unpleasant metallic taste. Ocular motor palsies and opthalmopareses are rare, occurring in 1-3 %, sometimes due to orbtial ischemia. Most cranial neuropathies heal within three months with the vessel. The annual stroke rate is 1.4 % overall.