This Article Extract Full Text (PDF) All Versions of this Article: 38/5/e16    most recent STROKEAHA.106.474551v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Menon, R. K. Articles by Norris, J. Search for Related Content PubMed PubMed Citation Articles by Menon, R. K. Articles by Norris, J.

(Stroke. 2007;38:e16.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Recurrent Carotid Artery Vasospasm or Dissection?

Ranjith K. Menon, MD

Clinical Neurosciences, St. Georges University of London, London, UK

John Norris, MD

Department of Clinical Neuroscience, St. Georges Hospital Medical School, London, UK

To the Editor:

We find the article by Janzarik et al¹ reporting extracranial artery vasospasm very unconvincing.

As the authors say, it is a rare phenomenon, if it ever occurs at all. Vasospasm was said to occur during direct insertion of the needle into the extracranial cervical arteries during angiography, but we suspect that in most if not all cases, the arterial narrowing was much more likely attributable to traumatic dissection.

In both patients we believe the authors’ initial diagnosis of carotid dissection was correct. The MRI illustrating the "string sign" would support this diagnosis, and the rapid resolution is completely compatible with healing of dissection. In any case, ultrasound diagnosis of dissection is much less accurate than MRI.² In addition both patients were young and the second patient had migraine, further supporting the diagnosis of cervical artery dissection.

The misdiagnosis of dissection as vasospasm has serious clinical implications because the current practice of giving antithrombotic treatment in patients with acute dissection would be inappropriate if the patient really has "idiopathic vasospasm".

Acknowledgments

Disclosures

None.

References

1. Janzarik WG, Ringleb PA, Reinhard M, Rauer S. Recurrent extracranial carotid artery vasospasms: report of 2 cases. Stroke. 2006; 37: 2170–2173.[Abstract/Free Full Text]
2. Benninger DH, Georgiadis D, Gandjour J, Baumgartner RW. Accuracy of color duplex ultrasound diagnosis of spontaneous carotid dissection causing ischemia. Stroke. 2006; 37: 377–381.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) All Versions of this Article: 38/5/e16    most recent STROKEAHA.106.474551v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Menon, R. K. Articles by Norris, J. Search for Related Content PubMed PubMed Citation Articles by Menon, R. K. Articles by Norris, J.