[Spontaneous dissection of the internal carotid artery in ophthalmological milieu. Apropos of 10 cases]

Abstract

Purpose: Spontaneous dissection of the internal carotid artery is a rare vascular emergency, but represents the first cause of cerebral ischaemia of young patients. Neuro-ophthalmologic symptoms often reveals the pathology.

Methods: Ten cases of spontaneous dissection of the internal artery are reported. The Claude Bernard Horner syndrome is the most frequent symptom typically associated with hemicranial headache. The headache involves the ipsilateral forequarter of the head and the neck. Other ophthalmologic symptoms may also reveal the carotid dissection.

Results: At first, the diagnosis is strongly suspected during Doppler ultrasonographic examination. During the acute phase, MRI and MRA replaces advantagiously arteriography, confirming this affection in a non invasive way, and permits investigation of associated vascular pathology like fibromuscular dysplasia (15% of the cases). The patients received anticoagulants in order to prevent thrombo-embolic complications (heparine during the acute phase relayed by AVK). The clinical course is usually favorable with the medical treatment.

Conclusion: A painful Claude Bernard Horner syndrome strongly evokes a carotid dissection and the arterial check-up must be realised in emergency: at first, the exploratory methods associates Doppler ultrasonographic examination, MRI, and MRA.