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.
Franco Accorsi, MD
Member of the Order of Physician of Bologna n° 6728
I am a specialist in Medical Angiology and I am based in Bologna, Italy. Until 2008 (voluntary resignation) I worked at Maggiore Hospital in Bologna as "Dirigente Medico" in the Department of Internal Medicine and as Angiologist in the Angiology Unit with a position of "Alta Professionalità" in "Vascular Ecography and Angiology".
I am currently working in Bologna as an independent professional in the areas of angiology and vascular diagnostics.
I have been a speaker at national and international courses/congress and I have taught duplex ultrasound method in GIUV and SIUMB courses at the Maggiore Hospital, Bologna and courses of echocolor Doppler of extracranial and intracranial arteries at the Stroke Unit of S. Maria Nuova Hospital, Reggio Emilia.