USEFULLNESS OF ULTRASONOGRAPHY IN SPONTANEOUS DISSECTION OF THE CERVICAL ARTERIES: REPORT OF A CASE

Purpose: Spontaneous dissection of the cervical arteries is a frequent cause of stroke in young and may be responsible of approximately 25% of the cases. Usually dissection involves only one artery; however, multiple vessel dissections may also occur, although less frequently. We report a patient who presented a dissection of all four cervical arteries with stroke occurring 9 days after admission at the hospital, despite anticoagulant treatment. The role of ultrasonography is further discussed.

Methods and Materials: case-report:a 46-years-old taxi-driver, otherwise in good health, was admitted because of unusual headache lasting for several days. Clinical examination revealed a right-sided Horner sign.

Results: CT-angiography and ultrasonographic investigation showed signs of dissection of the right carotid artery. Treatment with intravenous heparin was started. Ultrasound examination performed 5 days later didn't show any change. On the 9th day after admission, the patient complained suddenly of a right hemisyndrome involving the face and the upper limb.

Ultrasongraphic investigation showed this time signs of dissection of all four cervical arteries; and in particular, an occlusion of the left carotid artery. MR-angiography confrimed the presence of dissection of both carotid and vertebral arteries (right V3 and left V2 segments) and further revealed an ischemic lesion located on the left posterior borderzone. Because of signs of haemodynamic failure found on transcranial colour coded duplex sonography of the left middle cerabral artery as well as on perfuson MRI, angioplasty with stent was performed allowing recanalisation of the left carotid artery. The patient recovered clinically. Four weeks later, ultrasonographic examination showed partial recanalisation of the right carotid artery and a complete one of the vertebral arteries. After 5 months all 4 arteries were normal on ultrasound examination.

Conclusions: Dissection may involve progressively several cervical arteries and may cause stroke despite anticoagulant treatment adminstered for several days. This case further underlines the importance of repeated ultrasonographic controls during the acute stage of dissection in order to detect progressive worsening and extension to the remaining arteries.