Spontaneous Dissection and Stroke in Young Adults

What is your first idea when a 17-year old pregnantgirl presents with sudden tinnitus and hemianopsia? Spontaneous cervical carotid artery dissection (SCAD)is probably not on top of your list. This raredisease is a major cause of stroke in young adults.Various lesions have been described in associationwith SCAD, and several triggers and predisposingfactors are surmised. Besides providing an overviewon epidemiology, diagnosis and treatment of SCAD,this work contains a histological evaluation of thecarotid bifurcation on a control series obtainedduring forensic autopsies, in which lesions similarto those described for spontaneous cervical arterydissection were observed. These can be explained asreactive changes of smooth muscle cells (SMC) and thevascular wall in response to various stressors.Recent advances in vascular physiology are discussedto illustrate the concept of SMC phenotypicmodulation. There is a need to integrate knowledgefrom both vascular physiology and clinical pathologyin order to understand spontaneous arterial dissection. Keep in mind the chamaeleon nature of SCAD and maybethey will have cause to call you Dr. House one ofthese days!