Doc, I love you but my inner hypochondriac is going nuts right now...Comfort me please!
You crack me up, tech_diver.
Q1. Are these 'dissections' potentially fatal? Can they rupture? Can they grow to the size of a watermelon?
A1. Carotid artery dissection begins as a tear in one of the carotid arteries of the neck, allowing blood to enter the wall of the artery and split its layers. This can result in a hematoma between the arterial layers, aka a pseudoaneurysm, which can result in varying degrees of occlusion of blood flow and be a source of blot clots, with possible resulting obstructive stroke. And, yes, while it is not common, a pseudoaneurysm can rupture, with very grim result.
On the bright side, reported mortality for spontaneous internal carotid artery dissection is <5% & ~75% of patients make a good recovery. OTOH, dissections secondary to trauma have a much higher rate of mortality & morbidity. Given blunt trauma, 37-58% of patients have permanent neurologic deficits.
So, in that sense it's important which type of dissection one suffers. It seems to be the general practice to diagnose traumatic carotid artery dissection only when significant blunt (or penetrating) injury can be identified. However, IMHO there is a worrisome band of uncertainty between the spontaneous and traumatic variety.
The dissection described the chap in the article posted above, which is by no means the only published case of carotid artery dissection post-scuba, is a splendid example of what I mean. Was it spontaneous (i.e., without any identifiable cause such as trauma or arterial disease which could explain it) or was it traumatic (e.g., the result of stretching of the internal carotid artery secondary to positioning of the neck to facilitate equalization of the ears or to look upwards, or a too rapid ascent from depth)? He had only one reported risk factor, and a minor one at that, benign arterial hypertension. Yet, there also was no clear history of blunt or penetrating trauma to the artery.
Q2. What happens if they go untreated?
A2. Once one starts to manifest the signs & symptoms of cervical carotid dissection, it's quite unlikely s/he would not receive appropriate medical attention.
In general, this type of dissection can be conservatively managed with excellent anatomic & symptomatic resolution and low rates of recurrence. Management typically is by the use of anticoagulation (e.g., Coumadin (warfarin)) or antiplatelet (e.g., aspirin)) therapy. The patient in the linked case study was treated with aspirin and in fact did show such resolution.
Responsive?
Regards,
DocV
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.
---------- Post added November 1st, 2013 at 08:02 AM ----------
Is there any possibility of a summary using lay terms so that the general audience can understand it better?
Hi boulderjohn,
I appreciate the difficulty heavy medical terminology poses to the lay individual.
In my reply to tech_diver immediately above I endeavored mightly to express the topic in as clear & simple terminology as I could without doing gross injustice to the basics.
Did I do good?
Cheers,
DocV
