Stroke secondary to carotid dissection

Symptoms:

• facial pain occurring prior to other neurologic deficits
• neck pain occurring prior to other neurologic deficits
• pulsating noises may be present in the ear (pulsatile tinnitus)
• weakness or total inability to move a body part
• numbness, loss of sensation
• tingling or other abnormal sensations
• decreased or lost vision, partial or temporary
• language difficulties (aphasia)
• inability to recognize or identify sensory stimuli (agnosia)
• loss of memory
• vertigo (abnormal sensation of movement)
• loss of coordination
• swallowing difficulties
• personality changes
• mood and emotion changes
• urinary incontinence (lack of control over bladder)
• lack of control over the bowels
• eyelid drooping
• consciousness changes
  • sleepy
  • stuporous, somnolent, lethargic
  • comatose, unconscious

Signs and tests:

Maximum neurologic deficits may be present at the beginning (onset) of the stroke, or symptoms may progress or fluctuate for the first day or two (stroke in evolution). Once there is no further deterioration, the stroke is considered a complete stroke.

An examination may include neurologic, motor, and sensory testing to determine the specific neurologic problems present. The examination may show changes in vision or visual fields, changes in reflexes including abnormal reflexes or abnormal extent of "normal" reflexes, abnormal eye movements, muscle weakness, decreased sensation, and other changes. A bruit, an abnormal sound heard with the stethoscope, may be heard over the carotid arteries of the neck. The blood pressure may be high. Horner's syndrome may be present: drooping of one eyelid, lack of sweating on one side of the forehead, and a sunken appearance to one eye.

Tests (see also tests for stroke):

• a cerebral angiography reveals changes indicating carotid dissection
• a duplex/Doppler ultrasound can also detect dissection