Erdheim's medionecrosis aortica cystica is mechanism. usually related to injury or stressful event ,a few to fmd, Marfan's or Ehlers Danlos syndrome, osteogenesis imperfecta and alpha one antitrypsin deficiency. Interestingly, many have warnings of unilateral facial or cranial pain followed within minutes to days by dissection. The pain is nonthrobbing and usually centered in or around the eye, occassionally frontotemporal or at the angle of the mandible. Horners syndrome is common, rarely facial numbness and syncope. Mokri described 2 syndromes: 1) unilateral HA with ipsilateral Horner's, and 2) unilateral HA and delayed focal cerebral ischemic symptoms. Involvement of X, XI and XII nn may occur due to small twigs from carotid.
Per Ropper ,early recanalization of occluded artery in stroke patients is beneficial. Pseudoaneurysms may form, do not require surgery or preclude anticoagulation. Steroids relieve pain.
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