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(Circulation. 2007;115:e181-e185.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Common Carotid Dissection

A Sign of Emergency

Martin Sojer, MD; Heike Stockner, MD; Birgit Biedermann, MD; Michael Spiegel, MD; Christoph Schmidauer, MD

From the Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.

Correspondence to Martin Sojer, Department of Neurology, Medical University Innsbruck, Anichstrasse 35, A–6020, Innsbruck, Austria. E-mail martin.sojer@uki.at

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Patient 1 was a 58-year-old man who was brought to the emergency department after he collapsed in the kitchen. On arrival, the patient was comatose and did not react to pain stimuli. He was hypotensive (blood pressure 70/50 mm Hg), and ECG showed sinus tachycardia (120/min) with left bundle-branch block. Tests for troponin T were negative, and his D-dimer level was 3771 µg/L (normal range: 0 to 190 µg/L). Because of tachypnea and developing respiratory insufficiency, intubation became necessary. A massive pulmonary embolism was initially suspected.

Patient 2 was a 47-year-old man who suddenly collapsed with aphasia, right-sided hemiparesis, and progressive loss of consciousness. After intubation and during transportation to the emergency department, he was hypertensive, but on arrival he became hypotensive (blood pressure 80/60 mm Hg). An ECG showed sinus tachycardia (127/min) and marked ST depression in V₅ and V₆. Tests for troponin T were negative, and his D-dimer level was 212 µg/L. Cerebral bleeding with brain stem compression was on top of our list of differential diagnoses.

Patient 3 was a 57-year-old woman who came to our department because of dizziness and visual disturbance. After 1 day, she complained about persisting coldness and dysesthesia in her left arm. There was a blood pressure difference between her upper extremities (150/90 mm Hg on the right versus 100/90 mm Hg on the left). Her ECG and troponin T level were normal, and her D-dimer was 205 µg/L. Subclavian steel syndrome had to be excluded.

All patients had one symptom . . . [Full Text of this Article]

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