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May 14, 2013; 80 (20) NeuroImages

Carotid dissection following a generalized tonic-clonic seizure

Nicholas D. Child, Gregory D. Cascino
First published May 13, 2013, DOI: https://doi.org/10.1212/WNL.0b013e318292a356
Nicholas D. Child
From the Mayo Clinic, Rochester, MN.
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Gregory D. Cascino
From the Mayo Clinic, Rochester, MN.
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Carotid dissection following a generalized tonic-clonic seizure
Nicholas D. Child, Gregory D. Cascino
Neurology May 2013, 80 (20) 1911; DOI: 10.1212/WNL.0b013e318292a356

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A 37-year-old woman experienced a generalized tonic-clonic seizure. Subsequent to the seizure, the patient observed left-sided face and neck pain. A left Horner syndrome was noted on examination. An MRI and magnetic resonance angiogram revealed a left skull base carotid artery dissection without infarction (figure, A and B). Previous MRI had shown normal carotid flow voids. The patient was treated conservatively and magnetic resonance angiogram 1 month later revealed recanalization (figure, C).

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Figure Imaging findings in a patient with left internal carotid dissection

Magnetic resonance angiogram (A) and axial postcontrast (B) show dissection in left carotid artery (arrows). (C) Axial postcontrast 1 month later shows recanalization.

Carotid artery dissection has an incidence of 1.72 per 100,000.1 Although carotid artery dissection is reported in association with minor trauma, there are no reports occurring in association with a seizure.2

Footnotes

  • Author contributions: Nicholas D. Child and Gregory D. Cascino contributed to drafting and revising the manuscript. Dr. Cascino was responsible for the study concept.

  • Study funding: No targeted funding reported.

  • Disclosure: N. Child reports no disclosures. G. Cascino serves as an Associate Editor for Neurology®. Go to Neurology.org for full disclosures.

  • © 2013 American Academy of Neurology

References

  1. 1.↵
    1. Lee VH,
    2. Brown RD,
    3. Mandrekar JN,
    4. Mokri B
    . Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006;67:1809–1812.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Debette S,
    2. Leys D
    . Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 2009;8:668–678.
    OpenUrlCrossRefPubMed

Disputes & Debates: Rapid online correspondence

  • Response to Dr. Kraemer
    • Nicholas D. Child, Doctor, Mayo Clinicchild.nicholas@mayo.edu
    Submitted May 21, 2013
  • Seizure-associated arterial dissection
    • Guenter Kraemer, Medical Director, Swiss Epilepsy Center, Zurich, Switzerlandg.kraemer@swissepi.ch
    Submitted May 20, 2013
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