Carotid Artery Dissection

A carotid artery dissection begins with blood entering a tear or weakened plane within the arterial wall. The resulting intramural haematoma can compress the true lumen, but the more common route to ischaemic stroke is thrombus forming on the injured surface and embolising downstream. This is why a patient may have a normal or near-normal pulse in the neck yet develop sudden focal neurological deficits. The bedside pattern can be subtle: new unilateral head or neck pain may come first, followed hours or days later by retinal or cerebral ischaemia. Partial Horner syndrome, pulsatile tinnitus, or an isolated lower cranial-nerve deficit can be the warning sign. A young adult with stroke symptoms and prominent ipsilateral head or neck pain needs a different diagnostic question from a patient with typical atherosclerotic disease. The nurse should think beyond “stroke” to “stroke caused by a cervical artery problem,” because vascular imaging of the head and neck and careful assessment for intracranial extension affect treatment safety.