Spontaneous Dissection and Stroke in Young Adults

What is your first idea when a 17-year old pregnant girl presents with sudden tinnitus and hemianopsia? Spontaneous cervical carotid artery dissection (SCAD) is probably not on top of your list. This rare disease is a major cause of stroke in young adults. Various lesions have been described in association with SCAD and several triggers and predisposing factors are surmised. Besides providing an overview on epidemiology diagnosis and treatment of SCAD this work contains a histological evaluation of the carotid bifurcation on a control series obtained during forensic autopsies in which lesions similar to those described for spontaneous cervical artery dissection were observed. These can be explained as reactive changes of smooth muscle cells (SMC) and the vascular wall in response to various stressors. Recent advances in vascular physiology are discussed to illustrate the concept of SMC phenotypic modulation. There is a need to integrate knowledge from both vascular physiology and clinical pathology in order to understand spontaneous arterial dissection. Keep in mind the chamaeleon nature of SCAD and maybe they will have cause to call you Dr. House one of these days!