A Rare Case of Postpartum Carotid Dissection
Abstract
Cervicocranial arterial dissection is not a common disease (2.5% of total brain infarction), and its pathogenesis is still not fully understood. However, it appears to be multifactorial and is rarely seen in the postpartum period. A 40-year-old woman presented to the emergency department with sudden right lower limb paresis 10 days after vaginal delivery. She had no history of DM, HTN, preeclampsia, or underlying cerebrovascular disease. Upon evaluation, left extracranial carotid artery dissection was found on cervical MRA. The likelihood of postpartum dissection is rare, but it could be due to vascular damage associated with the Valsalva maneuver during labor; hemodynamic and hormonal changes due to pregnancy may also play a role.
[1] Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging
findings and differential diagnosis. Radiographics. 2008 Oct;28(6):1711-28. https://doi.org/10.1148/rg.286085512
[2] Patel RR, Adam R, Maldjian C, Lincoln CM, Yuen A, Arneja A. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol Rev. 2012 May-Jun;20(3):145-52. https://doi.org/10.1097/crd.0b013e318247cd15
[3] Nazzal M, Herial NA, Macnealy MW. Diagnostic imaging in carotid artery dissection: a case report and review of current modalities. Ann Vasc Surg. 2014 Apr;28(3):739.e5-9. https://doi.org/10.1016/j.avsg.2013.02.031
[4] Thanvi B, Munshi SK, Dawson SL, Robinson TG. Carotid and vertebral artery dissection syndromes. Postgrad Med J. 2005 Jun;81(956):383-8. https://doi.org/10.1136/pgmj.2003.016774
[5] Benninger DH, Georgiadis D, Gandjour J, Baumgartner RW. Accuracy of color duplex ultrasound diagnosis of
spontaneous carotid dissection causing ischemia. Stroke. 2006 Feb;37(2):377-81. https://doi.org/10.1161/01.
str.0000198811.65068.16
[6] Gardner DJ, Gosink BB, Kallman CE. Internal carotid artery dissections: duplex ultrasound imaging. J Ultrasound
Med. 1991 Nov;10(11):607-14. https://doi.org/10.7863/jum.1991.10.11.607
[7] Sturzenegger M. Ultrasound findings in spontaneous carotid artery dissection. The value of duplex sonography. Arch
Neurol. 1991 Oct;48(10):1057-63. https://doi.org/10.1001/archneur.1991.00530220079023
[8] Tola M, Yurdakul M, Cumhur T. B-flow imaging in low cervical internal carotid artery dissection. J Ultrasound
Med. 2005 Nov;24(11):1497-502. https://doi.org/10.7863/jum.2005.24.11.1497
[9] Busch T, Aleksic I, Sirbu H, Kersten J, Dalichau H. Complex traumatic dissection of right vertebral and bilateral carotid
arteries: a case report and literature review. Cardiovasc Surg. 2000 Jan;8(1):72-4. https://doi.org/10.1016/s0967-
2109(99)00075-7
[10] Nadgir RN, Loevner LA, Ahmed T, Moonis G, Chalela J, Slawek K, et al. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 2003 May;45(5):311-4. https://doi.org/10.1007/s00234-003-0944-x
[11] Kelly JC, Safain MG, Roguski M, Edlow AG, Malek AM. Postpartum internal carotid and vertebral arterial dissections.
Obstet Gynecol. 2014 Apr;123(4):848-56. https://doi.org/10.1097/aog.0000000000000189
[12] Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL. Risk of stroke and recurrent dissection after a cervical
artery dissection: a multicenter study. Neurology. 2003 Nov 25;61(10):1347-51. https://doi.org/10.1212/01.
wnl.0000094325.95097.86
[13] Baffour FI, Kirchoff-Torres KF, Einstein FH, Karakash S, Miller TS. Bilateral internal carotid artery dissection in the postpartum period. Obstet Gynecol. 2012 Feb;119(2 Pt 2):489-492. https://doi.org/10.1097/aog.0b013e318242d8d4
[14] Thapedi IM, Ashenhurst EM, Rozdilsky B. Spontaneous dissecting aneurysm of the internal carotid artery in the
neck. Report of a case and review of the literature. Arch Neurol. 1970 Dec;23(6):549-54. https://doi.org/10.1001/
archneur.1970.00480300071009
[15] Andersen CA, Collins GJ Jr, Rich NM, McDonald PT. Spontaneous dissection of the internal carotid artery associated with fibromuscular dysplasia. Am Surg. 1980 Apr;46(4):263-6.
[16] Brown OL, Armitage JL. Spontaneous dissecting aneurysms of the cervical internal carotid artery. Two case reports and a survey of the literature. Am J Roentgenol Radium Ther Nucl Med. 1973 Jul;118(3):648-53. https://doi.org/10.2214/
ajr.118.3.648
[17] Garcia-Merino JA, Gutierrez JA, Lopez-Lozano JJ, Marquez M, Lopez F, Liano H. Double lumen dissecting aneurysms
of the internal carotid artery in fibromuscular dysplasia: case report. Stroke. 1983 Sep-Oct;14(5):815-8. https://doi.
org/10.1161/01.str.14.5.815
[18] Gee W, Kaupp HA, McDonald KM, Lin FZ, Curry JL. Spontaneous dissection of internal carotid arteries: spontaneous resolution documented by serial ocular pneumoplethysmography and angiography. Arch Surg. 1980;115(8):944-9. https://doi.org/10.1001/archsurg.1980.01380080038008
[19] Dziewas R, Konrad C, Dräger B, et al. Cervical artery dissection: clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 2003;250(10):1179-84. https://doi.org/10.1007/s00415-003-0174-5
[20] Debette S, Metso T, Pezzini A, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation. 2011;123(14):1537-44.
[21] de Bray JM, Baumgartner RW. History of spontaneous dissection of the cervical carotid artery. Arch Neurol. 2005;62(7):1168-70. https://doi.org/10.1001/archneur.62.7.1168
[22] Bogousslavsky J, Despland PA, Regli F. Spontaneous carotid dissection with acute stroke. Arch Neurol. 1987;44(2):137-40. https://doi.org/10.1001/archneur.1987.00520140009010
[23] Baracchini C, Tonello S, Meneghetti G, et al. Neurosonographic monitoring of 105 spontaneous cervical artery dissections: a prospective study. Neurology. 2010;75(21):1864-70. https://doi.org/10.1212/WNL.0b013e3181feae5e
[24] Dittrich R, Nassenstein I, Bachmann R, et al. Polyarterial clustered recurrence of cervical artery dissection seems
to be the rule. Neurology. 2007;69(2):180-6. https://doi.org/10.1212/01.wnl.0000265595.50915.1e
[25] Silvestrini M, Altamura C, Cerqua R, et al. Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid arterydissection. Stroke. 2011;42(1):139-43. https://doi. org/10.1161/STROKEAHA.110.595843
[26] Leys D, Bandu L, Hénon H, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic
stroke. Neurology. 2002;59(1):26-33. https://doi.org/10.1212/wnl.59.1.26
[27] Patel RR, Adam R, Maldjian C, Lincoln CM, Yuen A, Arneja A. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol Rev. 2012;20(3):145-52. https://doi.org/10.1097/CRD.0b013e318247cd15
findings and differential diagnosis. Radiographics. 2008 Oct;28(6):1711-28. https://doi.org/10.1148/rg.286085512
[2] Patel RR, Adam R, Maldjian C, Lincoln CM, Yuen A, Arneja A. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol Rev. 2012 May-Jun;20(3):145-52. https://doi.org/10.1097/crd.0b013e318247cd15
[3] Nazzal M, Herial NA, Macnealy MW. Diagnostic imaging in carotid artery dissection: a case report and review of current modalities. Ann Vasc Surg. 2014 Apr;28(3):739.e5-9. https://doi.org/10.1016/j.avsg.2013.02.031
[4] Thanvi B, Munshi SK, Dawson SL, Robinson TG. Carotid and vertebral artery dissection syndromes. Postgrad Med J. 2005 Jun;81(956):383-8. https://doi.org/10.1136/pgmj.2003.016774
[5] Benninger DH, Georgiadis D, Gandjour J, Baumgartner RW. Accuracy of color duplex ultrasound diagnosis of
spontaneous carotid dissection causing ischemia. Stroke. 2006 Feb;37(2):377-81. https://doi.org/10.1161/01.
str.0000198811.65068.16
[6] Gardner DJ, Gosink BB, Kallman CE. Internal carotid artery dissections: duplex ultrasound imaging. J Ultrasound
Med. 1991 Nov;10(11):607-14. https://doi.org/10.7863/jum.1991.10.11.607
[7] Sturzenegger M. Ultrasound findings in spontaneous carotid artery dissection. The value of duplex sonography. Arch
Neurol. 1991 Oct;48(10):1057-63. https://doi.org/10.1001/archneur.1991.00530220079023
[8] Tola M, Yurdakul M, Cumhur T. B-flow imaging in low cervical internal carotid artery dissection. J Ultrasound
Med. 2005 Nov;24(11):1497-502. https://doi.org/10.7863/jum.2005.24.11.1497
[9] Busch T, Aleksic I, Sirbu H, Kersten J, Dalichau H. Complex traumatic dissection of right vertebral and bilateral carotid
arteries: a case report and literature review. Cardiovasc Surg. 2000 Jan;8(1):72-4. https://doi.org/10.1016/s0967-
2109(99)00075-7
[10] Nadgir RN, Loevner LA, Ahmed T, Moonis G, Chalela J, Slawek K, et al. Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. Neuroradiology. 2003 May;45(5):311-4. https://doi.org/10.1007/s00234-003-0944-x
[11] Kelly JC, Safain MG, Roguski M, Edlow AG, Malek AM. Postpartum internal carotid and vertebral arterial dissections.
Obstet Gynecol. 2014 Apr;123(4):848-56. https://doi.org/10.1097/aog.0000000000000189
[12] Touzé E, Gauvrit JY, Moulin T, Meder JF, Bracard S, Mas JL. Risk of stroke and recurrent dissection after a cervical
artery dissection: a multicenter study. Neurology. 2003 Nov 25;61(10):1347-51. https://doi.org/10.1212/01.
wnl.0000094325.95097.86
[13] Baffour FI, Kirchoff-Torres KF, Einstein FH, Karakash S, Miller TS. Bilateral internal carotid artery dissection in the postpartum period. Obstet Gynecol. 2012 Feb;119(2 Pt 2):489-492. https://doi.org/10.1097/aog.0b013e318242d8d4
[14] Thapedi IM, Ashenhurst EM, Rozdilsky B. Spontaneous dissecting aneurysm of the internal carotid artery in the
neck. Report of a case and review of the literature. Arch Neurol. 1970 Dec;23(6):549-54. https://doi.org/10.1001/
archneur.1970.00480300071009
[15] Andersen CA, Collins GJ Jr, Rich NM, McDonald PT. Spontaneous dissection of the internal carotid artery associated with fibromuscular dysplasia. Am Surg. 1980 Apr;46(4):263-6.
[16] Brown OL, Armitage JL. Spontaneous dissecting aneurysms of the cervical internal carotid artery. Two case reports and a survey of the literature. Am J Roentgenol Radium Ther Nucl Med. 1973 Jul;118(3):648-53. https://doi.org/10.2214/
ajr.118.3.648
[17] Garcia-Merino JA, Gutierrez JA, Lopez-Lozano JJ, Marquez M, Lopez F, Liano H. Double lumen dissecting aneurysms
of the internal carotid artery in fibromuscular dysplasia: case report. Stroke. 1983 Sep-Oct;14(5):815-8. https://doi.
org/10.1161/01.str.14.5.815
[18] Gee W, Kaupp HA, McDonald KM, Lin FZ, Curry JL. Spontaneous dissection of internal carotid arteries: spontaneous resolution documented by serial ocular pneumoplethysmography and angiography. Arch Surg. 1980;115(8):944-9. https://doi.org/10.1001/archsurg.1980.01380080038008
[19] Dziewas R, Konrad C, Dräger B, et al. Cervical artery dissection: clinical features, risk factors, therapy and outcome in 126 patients. J Neurol. 2003;250(10):1179-84. https://doi.org/10.1007/s00415-003-0174-5
[20] Debette S, Metso T, Pezzini A, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation. 2011;123(14):1537-44.
[21] de Bray JM, Baumgartner RW. History of spontaneous dissection of the cervical carotid artery. Arch Neurol. 2005;62(7):1168-70. https://doi.org/10.1001/archneur.62.7.1168
[22] Bogousslavsky J, Despland PA, Regli F. Spontaneous carotid dissection with acute stroke. Arch Neurol. 1987;44(2):137-40. https://doi.org/10.1001/archneur.1987.00520140009010
[23] Baracchini C, Tonello S, Meneghetti G, et al. Neurosonographic monitoring of 105 spontaneous cervical artery dissections: a prospective study. Neurology. 2010;75(21):1864-70. https://doi.org/10.1212/WNL.0b013e3181feae5e
[24] Dittrich R, Nassenstein I, Bachmann R, et al. Polyarterial clustered recurrence of cervical artery dissection seems
to be the rule. Neurology. 2007;69(2):180-6. https://doi.org/10.1212/01.wnl.0000265595.50915.1e
[25] Silvestrini M, Altamura C, Cerqua R, et al. Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid arterydissection. Stroke. 2011;42(1):139-43. https://doi. org/10.1161/STROKEAHA.110.595843
[26] Leys D, Bandu L, Hénon H, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic
stroke. Neurology. 2002;59(1):26-33. https://doi.org/10.1212/wnl.59.1.26
[27] Patel RR, Adam R, Maldjian C, Lincoln CM, Yuen A, Arneja A. Cervical carotid artery dissection: current review of diagnosis and treatment. Cardiol Rev. 2012;20(3):145-52. https://doi.org/10.1097/CRD.0b013e318247cd15
| Files | ||
| Issue | Vol 9 No 5 (2024): September -October | |
| Section | Case Report(s) | |
| Keywords | ||
| Postpartum period Cervicocephalic arterial dissection Ischemic stroke | ||
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How to Cite
1.
Abutorabi Zarchi M, Kazemzadeh Houjaghan A. A Rare Case of Postpartum Carotid Dissection. CRCP. 2025;9(5):217-220.
