A bilateral internal carotid artery dissection presenting with atypical symptoms of cerebral hypoperfusion has been rarely reported, especially in the absence of obvious precipitating factors. A middle-aged woman presented to the emergency department with a 2-day-history of progressive left arm numbness and weakness, confusion, disorientation and clumsiness worsened by upright position. A cerebral hypoperfusion condition was hypothesized and confirmed by a CT angiography, which showed bilateral internal carotid dissection with uncertain etiology. Screening for predisposing conditions to spontaneous carotid arteries dissection was basically negative. Regarding potential precipitating factors, the patient had used an electric olive harvester days before symptoms onset, without any painful sensation or sudden sequelae. Portable harvesters in olive growing transmit vibrations to the hand-arm system but it remains to be elucidated if hand-arm vibrations can be implicated in vessels wall injury and dissection. Bilateral carotid artery dissection is an infrequent and life-threatening condition which can rarely present with non-specific symptoms of cerebral hypoperfusion. The absence of typical symptoms and known precipitating factors can made the diagnosis quite hard to achieve.

Rispoli M.G., Di Stefano V., Ajdinaj P., Onofrj M., De Angelis M.V. (2021). Unusual Presentation of Bilateral Carotid Artery Dissection: The Importance of Reasoning Outside the Box. ANNALS OF VASCULAR SURGERY, 74, 521.e9-521.e13 [10.1016/j.avsg.2021.01.090].

Unusual Presentation of Bilateral Carotid Artery Dissection: The Importance of Reasoning Outside the Box

Di Stefano V.
Secondo
;
2021-07-01

Abstract

A bilateral internal carotid artery dissection presenting with atypical symptoms of cerebral hypoperfusion has been rarely reported, especially in the absence of obvious precipitating factors. A middle-aged woman presented to the emergency department with a 2-day-history of progressive left arm numbness and weakness, confusion, disorientation and clumsiness worsened by upright position. A cerebral hypoperfusion condition was hypothesized and confirmed by a CT angiography, which showed bilateral internal carotid dissection with uncertain etiology. Screening for predisposing conditions to spontaneous carotid arteries dissection was basically negative. Regarding potential precipitating factors, the patient had used an electric olive harvester days before symptoms onset, without any painful sensation or sudden sequelae. Portable harvesters in olive growing transmit vibrations to the hand-arm system but it remains to be elucidated if hand-arm vibrations can be implicated in vessels wall injury and dissection. Bilateral carotid artery dissection is an infrequent and life-threatening condition which can rarely present with non-specific symptoms of cerebral hypoperfusion. The absence of typical symptoms and known precipitating factors can made the diagnosis quite hard to achieve.
Settore MED/26 - Neurologia
Rispoli M.G., Di Stefano V., Ajdinaj P., Onofrj M., De Angelis M.V. (2021). Unusual Presentation of Bilateral Carotid Artery Dissection: The Importance of Reasoning Outside the Box. ANNALS OF VASCULAR SURGERY, 74, 521.e9-521.e13 [10.1016/j.avsg.2021.01.090].
File in questo prodotto:
File Dimensione Formato  
S0890509621001448.pdf

Solo gestori archvio

Tipologia: Post-print
Dimensione 858.73 kB
Formato Adobe PDF
858.73 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10447/520486
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 0
  • ???jsp.display-item.citation.isi??? 0
social impact