Carotid Artery Dissection, a Ticking Time Bomb

Updated on November 16, 2016
ExpressionsForLif profile image

Lorena Wood has a BS in Psychology and a Certificate from The School of Life. She is a Writer, Professor, and hard working matriarch.

Live-Giving Blood Supply

See those beautiful red tubes running up the neck and into the brain? Those are the carotid arteries. These two large arteries bring the blood supply to the brain, and if the supply is interrupted, we may only have minutes before damage is done. One event that can disrupt this precious blood supply is a dissection, or a tear, inside the inner lining of the blood vessel.

The 3 Layers Inside Your Arteries

Layers of the artery
Layers of the artery | Source

Carotid Arteries and the Brain

Source

What Happens When Your Carotid Artery Tears?

We've probably all heard the word aneurysm, but I had never heard about dissection before this happened. We were told that our arteries have 3 layers, and the inside layer sometimes tears.

Once there is a small tear, blood sneaks through that hole and pools between the outer and middle layer. Of course, the body tries to heal itself, and so clotting begins to occur. Now you have a bulging bubble of blood and clots, and that can only lead to serious trouble. Stroke can occur when the clots let loose and move into the brain. Some people get bad headaches, and many are misdiagnosed until they actual present with the stroke. We were lucky. My husband had a rare side effect that helped us to catch the dissection before the stroke occurred.

Something Is Wrong: Follow Your Instincts

My husband woke up one Sunday morning, the last Sunday in 2013, and his eye looked puffy. We both thought it was from his sinus/upper respiratory infection. He'd started antibiotics the day before, so no big deal, right?

Thankfully, I decided to call the doctor to ask if we should be concerned, and then opened my trusty laptop. Always Google medical conditions so you can find out the full list of crazy things you might have. No, I'm kidding. But I do like to Google medical things to be sure I am informed and knowledgeable, and because I love medical stuff. Good thing.

One site said it could be from blood clots, but I didn't think it was that. It said, check the pupils in the eyes. OK. So I told my hubby to let me check. BOOM! Life changing moment. One pupil was tiny and barely responsive. It wouldn't open right. That was the eye that looked puffy. Time for a trip to the emergency room!

So, I tell my husband his pupil is wonky and we need to get to the emergency room. However, he is only 47, and he's a very strong, healthy man.

He says, "No, let's wait to see what the doctor says."

Me, "Um, NO. We are leaving now!"

I love my big strong man, and I understand his reluctance, but some things aren't up for negotiation. On the way to the hospital, my phone rang and he answered it. It was the doctor's office calling to be sure we were on our way to the emergency room.

Everyone we met after that took one look, listened to the story, and then hurried to find out what was wrong. We have a few funny stories on the way. First, the triage nurse asked a bunch of questions, in a quiet, bored manner. He finally looked up and said, you are on antibiotics, so why are you here?

"His eye," I say emphatically.

After an eye test and flashlight in his face, the nurse says, "Wait outside until we call you." He then turns, before we leave the room, and slides open a small window. He calls out to the next room, "Where is the full arrest cart? Make sure we have it ready."

My husband turns to me and tells me he doesn't like the sound of that. I tell him it isn't about him. Silly worrier. Huh. He was right. We were quickly taken to a room, seen by a doctor, and he was sent for a CT scan. Definitely not the usual slow process I've experienced in emergency rooms before. Then they moved him out of his room, into a small side area, and ten minutes later they wheeled him into a bigger room.

Hubby sees the sign saying Trauma Room and asks the nurse, "Why am I in the Trauma room?"

Nurse, "Oh, they just name the rooms. That's just the name for this one."

Right. Then the doctor comes in an stammers a bit. He stops and says, "Let me start over. You have a carotid artery dissection."

As he goes on to explain what it means, the nurses are rushing to start two IVs, one in each arm. One nurse says, "Sorry, we have to put a big needle on this side in case we need to get meds in you fast. This will hurt."

Once the heparin (blood thinner) is started, they rush Roger up to ICU. They are talking about surgery, and sending him to a bigger hospital an hour away. It takes less than an hour to hear from the Vascular Surgeon. His dissection is too dangerous to consider operating on at this time. We get to stay in our hometown, and hope the doctors can fix this with medicine.

He is checked constantly in ICU, and the next morning we begin to see doctors. He ends up with four on the case. His General doctor, the vascular surgeon, a neurologist, and a cardiologist. They are all amazed and intrigued by his case. He is one in a million. The doctor in charge of the E.R. for the night comes to tell us he's never seen a case like Roger's, and he probably never will again. Roger has a rare condition called Horner's Syndrome, and it probably saved him from a stroke, or worse.

Horner's is the name of the syndrome that comes when the nerves to the eye are damaged and the pupil stops responding, the eye droops, and there is intense pain and pressure. If we hadn't noticed that, he would have gone on to the next step, and probably had a stroke. Horner's can be caused by a few different things,and one is when the carotid artery dissects, and then the bulge pushes on the nerves to the face. He is now in pain from that, but his brain is intact.

Contributing Factors

Why does the dissection happen? That is a good question, and one that hasn't been completely answered. There are two different kinds. One is from trauma, like in a car accident, and the other is called spontaneous dissection. My husband's was the second one, though they think a rather violent sneeze caused the tear. My kids are now afraid to sneeze, but there were other factors involved.

First, the condition of the artery is considered. As we age, and depending on our lifestyle, our arteries can become less elastic. Smoking, high cholesterol, and high blood pressure all take a toll on our vascular system. My husband had smoked for over 10 years, and his blood pressure had recently been crawling higher and higher. It was only a few months, and the doctors were at a point where, if his pressure didn't go down, they were going to prescribe medicine for that.

For some unknown reason, a good percentage of people who have had a carotid artery dissection, or CAD, have had an upper respiratory infection just previous to the event. My husband was quite sick with a bad cough and was on antibiotics and over-the-counter cold medicine. This may have raised his blood pressure even more. If there is a tear, and the blood is forcefully pushing through the artery, the lining will rip even farther. His tear starts low on his neck and goes all the way up into his skull.

Our neurologist said to picture a rug, and when a piece rips and is then pushed by a flood of water, it can roll right up as it goes. Or picture a fruit roll up. Either way, the flap of tissue that tore rolled up and blocked (occluded) his artery 90%. They aren't sure if that will get better as it heals. It may stay blocked, or it may open up some. Only time will tell.

So now, he is not supposed to stress, lift his arms up over his shoulders, lift more than 10 lbs, stretch, twist, cough, sneeze, or strain. You get the idea. Plus he is in pain from the nerve damage and possibly the healing process. It is a long recovery, and chances are good that he will never go back to his construction job. He'd worked his way up to a well respected position, and a decent career. Now we have no income, and his life has changed...but don't stress.

This will be a learning experience from here on out. Learning how to start over in middle age. Learning how to lower stress in our lives. Learning to appreciate family and the good friends that have been there to help us through this. Learning to take better care of ourselves. The wonderful part is that we still have Roger with us. The rest we can deal with. One thing that has helped is finding a group on Facebook of other CAD survivors. If there are more of you out there, please comment so we can get in touch. You know how important that can be as he is healing.

Enjoy each day, and don't let the little things ruin the good in life. We are thankful for each day we have together to continue learning and loving.

Eating Healthy Is Now a Priority

Eating to promote a healthy heart has become a new way of life in our family. We used to alternate between eating healthy and then opting for faster, cheaper alternatives when things got busy. We no longer have that luxury.

Since Roger must keep his blood pressure low, a low-salt diet is essential. That means no processed food. In addition, we are upping the fresh fruit containing vitamin C for healthy blood vessels. We have also reduced the amount of red meat and fat in our diets.

We have discovered some great new recipes, and I will work to share them on another article soon. Take care, and hug your loved ones today.

Dissection or Horner's Syndrome

Do you know anyone With a Dissection of an Artery, or Horner's Syndrome?

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Comments

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  • profile image

    valeriehall713 

    12 months ago

    Hi Everyone,

    I woke up in October of 2016 with Horner's Syndrome from a spontaneous dissection (right) and was treated at two (2) different hospitals in Phoenix. They both said I had Bell's Palsy and sent me home. It wasn't until I went to my eye doctor that I was sent to the proper facility where an MRA was performed and the dissection was found. My dissection is considered chronic and was wondering if anyone else had that diagnosis. Thank you and be well!

  • ExpressionsForLif profile imageAUTHOR

    Lorena Wood 

    19 months ago

    Sandra RN. I'm sorry you are in our new club. It is interesting to hear this from a RN point of view. I wish doctors knew more. They don't understand the pain, or at least we haven't met any that do yet. My husband is now 3 years out and still has the right sided face and head pain. He is still learning to live with it, with some pain medications and limitations. It's been a long three years.

  • profile image

    Sandra RN 

    20 months ago

    I also suffered an internal carotid artery dissection about 6 months ago. I was treated at Cedars Sinai in LA and my experience was quite different. I also presented with Horner's Syndrome. I had been experiencing what I thought was eye fatigue as I was working a lot(I'm an RN). When I realized my pupil was sluggish to respond to light I went to the ER immediately thank God!!

    I was seen right away and CT angio was done probably within 2 hours of being in the ER. After diagnosis I was heparinized to break up any clots that could cause stroke. I was kept for about 3 days on a non monitored neuro/stroke floor. I had an MRI to rule out any strokes I had a transcranial Doppler to detect any clots that might have already been formed. My dissection was deemed to be stable and I was sent home on aspirin 325mg daily.

    The pain didn't really set in for about 10 days. I am a migraine sufferer which complicates my treatment. The pain is referred to as a neuralgia and affects mostly the left side of my face specifically my left temple. I am unable to take my Imitrex for migraines as it may further impair blood flow to the brain. It's been a long haul fighting with my HMO to get necessary pain management treatments.

    I had a total of 6 weeks off work before returning to my duties as an RN

    It looks like there has been little healing as seen on my follow up CT and MRI.

    Would love to hear about others healing process and treatment course. Anybody had cerebral angiograms or stents??

  • profile image

    Hstevens07 

    3 years ago

    I am so glad I found this article, and feel as though I'm somewhat reading my story!

    Only difference being that I am a 32 year old women that has been fairly healthy without high blood pressure or cholesterol up until immediately before it happened. That, and I was sent home from the ER three different times before they found what it was. I had the severe headache, and extreme pain right above my left eye, and in the back of my head going down my neck along with shoulder pain going down my left arm. I also had extremely high blood pressure (180's) and a very high d-dimer level which usually indicates clotting somewhere in the body. They found that out on my first Er visit (two weeks prior to finding the dissection) and then sent me home saying I would be fine after they found no clots in my lungs or brain. I had been diagnosed with strep throat right before I was diagnosed with the dissection, which actually turned out to be a huge blessing from God because that is the only reason they did a ct angio scan of my neck thinking I possibly had mastitis of the bone based on where the pain was located in the back of my head and neck and can be a complication of strep. I found out later that the doctor who ordered that CT scan saved my life, because had he not I would have had a stroke, and based on where the tear is located, odds are that if I had survived it, I would have been a vegetable.

    The other difference is that unfortunately my dissection has gotten worse in theast two weeks instead of improving, and there are two tears, one at the C1 vertebrae and one just prior to the dura (this is the one that is extremely dangerous right now because it has doubled in size) This unfortunately means that not only am I still at risk for stroking, but we also still don't really know where we go from here.

  • ExpressionsForLif profile imageAUTHOR

    Lorena Wood 

    3 years ago

    Kimberlee,

    I just followed you on Twitter so I can read your story, and stay connected. I'm @LorenaWood15.

    The facebook page is https://www.facebook.com/groups/47265659349

    One thing I should warn you about. It's great when you are new and need support, but some stories are scary. Not everyone recovers as well as you and my hubby. Some may have other issues, or may not take their meds or follow doctors. You positive story will encourage others there. So glad you are healing well and have a second chance on life!!

  • KimberleeKDodd profile image

    KimberleeKDodd 

    3 years ago

    What is the mentioned Facebook page for Carotid Artery Dissection survivors?

    My story is tweeted @KimberleeKDodd on 10-28-14.

  • KimberleeKDodd profile image

    KimberleeKDodd 

    3 years ago

    I had a Carotid Artery Dissection May 2014. The stories above sound very similar to mine. 80-90% blockage. Right-brain stroke. Speech impaired, slowly came back. Leaking vessel in right eye healed. Left shoulder still bothers me. I was treated with Plavix, 325mg aspirin, Lipitor, Protonix, and blood pressure medicine. 6 mth scan in December revealed complete healing and complete clearing!

  • ExpressionsForLif profile imageAUTHOR

    Lorena Wood 

    3 years ago

    MBDamorano So sorry to hear about your serious health issues at such a young age. Wow. My husband is healing, but not 100% yet. At 6 months he thought he would be stuck with all the pain and issues, but now, at 10 months I can tell you he is still improving. His horners is much better, though it still acts up when tired and all that. The pain has decreased, and he recovers much faster when he does overdo things. The one thing he did that I encourage....is to...REST in the beginning!!!! REST and HEAL. Take your meds and let your body heal. Bodies can heal even a year after an event. Good luck!!

  • profile image

    mbdamoreno 

    3 years ago

    I am 23 years old. I had my dissection last year at 22. I'm a healthy female with no history of health problems. I too had horners syndrome and still have it to this day. My right eye droops if I'm to hot, stressed, tired or upset and especially with headache. I'm on blood thinners for the rest of my life and still have a slight tear and see a neurologist every 3 months. My once perfect vision is now almost gone in my right eye and i have thousands in medical debt. I'm so glad I'm not the only one out there with this. The hospital i went too also was perplexed as to why this happened, i did have a sinus infection around the same time as well. I hope your husband is well. It really is a struggle to be so limited on what you can do.

  • ExpressionsForLif profile imageAUTHOR

    Lorena Wood 

    4 years ago

    I added you on Twitter. @LorenaWood15 Take it easy and let things heal. My hubby's blood clot has resolved and blood flow is better. Still can't risk tearing more. Imaging in June will be 6 month mark. Hoping for good news.

  • profile image

    Patrick Konen 

    4 years ago

    I could not believe what i was reading, because I have a dissecting interior carotid artery that is completely blocked with a 2 in. blood clot. The surgeons are afraid to touch it and am on blood thinners. They did an MRI and confirmed I have a tear inside the artery. Am 50 years old and can't return to work as a correctional officer. Please twitter me at@kids2355

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