Your arteries carry blood from your heart to the rest of your body. You have two pairs of large arteries on each side of your neck. There are the two carotid arteries and the two vertebral arteries, and they carry blood to your brain. The diagram below show one of the carotid arteries and one of the vertebral ones, as the illustration is a side view.
If you have cervical artery dissection, the wall of one of these arteries has torn. This is more likely to happen in your carotid arteries than in the vertebral arteries. Once a tear develops, blood can stick to it and grow into a clot, which can block the artery where the tear is. Or, part or all of the clot can break off and block the artery further up.
If an artery becomes blocked by a blood clot, this can cause a stroke. When you have a stroke, the blood supply to your brain is affected and this damages brain cells. A stroke is a brain injury and, depending on where in your brain the stroke happens, it could affect your movement, sensation, speech, vision and thinking.
The symptoms of cervical artery dissection can be vague and wide-ranging. It depends on which artery has been affected and how severely, and whether or not you have a stroke as a result.
Some of the main symptoms of cervical artery dissection include:
- a severe headache
- pain in your face and neck
- problems with your sight, including temporarily losing your sight completely
- migraine symptoms such as shimmering lights in your vision
- a drooping eyelid, which can be very painful
- swollen neck
- pulsating tinnitus (a rhythmic noise that often beats in time to your heart)
If you have a stroke as a result of cervical artery dissection, you may get other symptoms . These include:
- pain and numbness on one side of your face
- changes in sensation in your body and limbs
- a feeling of moving or spinning when you’re not (vertigo)
- nausea and being sick
If these symptoms come on suddenly or happen after you’ve injured your neck, seek emergency help immediately.
Your doctor will ask about your symptoms and examine you. Your doctor will also need to know about any recent injury or activity that may have caused a tear in one of the cervical arteries.
There are several different tests that can help to show a cervical artery dissection. You may have one or more of the following.
- An MRI (magnetic resonance imaging) scan or a CT scan. These create detailed images of your head and neck. Both scans are sometimes done with angiogram. During an angiogram, dye is injected into your arteries. This helps your doctor to see them in more detail.
- An ultrasound scan of your arteries. This is a scan that uses sound waves to produce an image of your blood vessels.
The treatment you need will depend on:
- how big the tear is
- where the tear is
- how quickly you can be treated
- if you have any complications
Treatment for cervical artery dissection usually aims to prevent complications, such as a stroke, while your artery heals. This usually takes about three to six months.
If you’re diagnosed and can get medical help quickly (that is, within three to four-and-a-half hours), you may have a treatment called thrombolysis. Your doctor will give you a medicine called a fibrinolytic that is injected into a vein. This breaks up blood clots, but it can only be given in the first few hours after an injury.
You will probably be asked to take medicines to prevent blood clots. There are two main types:
- anticoagulants, such as heparin and warfarin
- antiplatelet medicines, such as aspirin or clopidogrel
If you can’t take anticoagulant or antiplatelet medicines or if the medicines aren’t working, your doctor may suggest an operation. An angioplasty and stenting procedure can help to prevent blood clots forming. But this isn’t a standard option and may only be offered in rare circumstances.
Cervical artery dissection can be caused by sudden movement of your neck or an injury to your neck, including:
- high-impact injuries, such as from a car crash
- minor neck injuries, such as from doing judo or yoga
- neck strain from activities such as overhead painting
- stretching, coughing, sneezing or vomiting
There is some debate about whether chiropractic treatment can cause cervical artery dissection – please see our FAQ ‘Chiropractic treatment’ about this.
Cervical artery dissection can also be caused by an underlying condition that leads to weakening of your blood vessels. This includes inherited conditions such as Ehlers–Danlos syndrome and Marfan syndrome.
Viral infections are also thought to potentially increase the risk of cervical artery dissection.
Cervical artery dissection can also just happen, without any obvious injury or underlying condition.
If you have a cervical artery dissection, you may develop complications. Some people develop headaches, which can last on and off for years. Others go on to have a stroke, which can sometimes cause severe disability and be life-threatening.
Cranial nerve palsies are also a complication of cervical artery dissection. A palsy is caused if a cranial nerve close to your carotid artery is compressed (squashed). Palsy can affect your eyes and tongue causing drooping eyelid and weakness of your tongue.
Research studies looking at whether or not spinal manipulation, as in chiropractic therapy, cause cervical artery dissection haven’t found a clear answer.
An association has been suggested between spinal manipulation and cervical artery dissection, particularly concerning the vertebral artery. But experts don’t know if it was because of the treatment or because the patient already had cervical artery dissection.
For example, if you develop cervical artery dissection, you could develop neck pain and go to a chiropractor for treatment. Or you could develop cervical artery dissection after treatment for neck pain. This means it’s not possible to know whether the cervical artery dissection was there before treatment or whether it developed because of the treatment.
Chiropractic treatment is regulated by law. Chiropractors must be properly trained and registered with the General Chiropractic Council. Before you have any treatment with a chiropractor, check that they are registered and ask any questions you have.
Warfarin prevents blood clots by increasing the time it takes the blood to clot. This is often referred to as ‘blood thinning’. However, sometimes the dose of warfarin isn’t quite right and your blood can become too 'thin'. This can cause bleeding. For this reason, you’ll need to be carefully monitored when you take warfarin.
The monitoring is done by regular blood tests to check how quickly your blood is clotting. The tests measure INR (international normalised ratio). How often the tests are done depends on what the results are.
Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.
Cervical artery dissection can sometimes be caused by small injuries, such as a sudden movement in your neck or having your neck in an unusual position. So, lying back with your neck resting on a sink at the hairdressers could possibly cause an injury that might lead to cervical artery dissection. However, there are very few reported cases where this has or might have happened.
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Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, May 2016.
Peer reviewed by Dr Ahamad Hassan, Consultant Neurologist and Stroke Physician.
New review due May 2019.
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