Cervical-artery dissection is the major cause of cerebral ischemia in young adults. Carotid dissection, defined as the splitting of the arterial wall of the carotid artery, is a dynamic process: morphological and clinical findings may change within days or hours.  

The echo-color Doppler is an excellent tool in screening for carotid dissection, but with limits. The most frequent echo-color Doppler sign is the “indirect“, non-specific, sign: origin of internal carotid artery (ICA) with high resistance flow pattern to a stenotic hematoma in the cervical ICA segment not explored directly with the ultrasound. This echo-color Doppler sign is also present in atherosclerotic or cardio embolic occlusion of the distal ICA segment. It should indicate the possibility of a dissection in an appropriate clinical setting (young patient with unilateral headache or partial Horner’s syndrome and followed by cerebral or retinal ischemia).

In this lesson, three case reports with echo-color Doppler "indirect" signs of carotid dissection will be presented: in particular, the importance of the clinic, of the early execution (to establish the correct medical or interventional treatment), and of the follow-up will be shown.

Carotid Dissection: three cases