Spontaneous dissection of the internal carotid artery.: A report of two cases

Introduction. Dissection of the internal carotid artery, is a condition with a broad clinical spectrum, In absence of the classical triad of cervical pain, oculosympathetic ipsilateral paralysis and ischemic cerebral symptoms a considerable index of clinical suspicion is necessary to make a diagnosis. It is therefore considered to be probably underdiagnosed. The development of new techniques for neurovascular investigation, particularly ultrasound and magnetic angioresonance have improved the possibilities of diagnosis. Clinical cases. In this paper we describe two cases of dissection of the internal carotid artery representing different clinical findings in the same condition. One patient presented with unilateral paralysis of the XI, X and XII cranial nerves and the other with transient ischemic cerebral accidents. In both cases the provisional diagnosis was made in function of the duplex findings of the supra-aortic trunks and confirmed by magnetic angioresonance studies. Both patients made satisfactory progress with complete recanalization of the vessels and no recurrence of symptoms after several months of follow-up. Conclusion. We discuss the different clinical characteristics and findings ofthe neurovascular examinations [REV NEUROL 1999; 29: 606-10].