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Spontaneous Dissection and Stroke in Young Adults
Vascular Physiology, Clinical and Forensic Medicine:An Interdisciplinary Appraisal of the Pathway TowardsSpontaneous Cervical Carotid Dissection
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What is your first idea when a 17-year old pregnant girlpresents with sudden tinnitus and hemianopsia? Spontaneous cervicalcarotid artery dissection (SCAD) is probably not on top of yourlist. This rare disease is a major cause of stroke in young adults.Various lesions have been described in association with SCAD, andseveral triggers and predisposing factors are surmised. Besidesproviding an overview on epidemiology, diagnosis and treatment ofSCAD, this work contains a histological evaluation of the carotidbifurcation on a control series obtained during forensic autopsies,in which lesions similar to those described for spontaneouscervical artery dissection were observed. These can be explained asreactive changes of smooth muscle cells (SMC) and the vascular wallin response to various stressors. Recent advances in vascularphysiology are discussed to illustrate the concept of SMCphenotypic modulation. There is a need to integrate knowledge fromboth vascular physiology and clinical pathology in order tounderstand spontaneous arterial dissection. Keep in mind thechamaeleon nature of SCAD and maybe they will have cause to callyou Dr. House one of these days!
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