Spontaneous Dissecting Aneurysm of the Internal Carotid Artery

A case of spontaneous dissection of the internal carotid artery is presented and the ten other reported cases are reviewed. It is most common in males aged 35 to 41 years. Of eight patients with neurological symptoms, two had transient hemiplegia and five of six first seen with a severe neurological deficit had prodromal symptoms. Angiography revealed a typical “string sign.” A method of surgical treatment is illustrated. The importance of emergency angiography and surgery in patients with acute onset of progressive symptoms of cerebral vascular disease is emphasized by this case. The surgical specimen was studied pathologically by serial section. At its origin the dissection measured 3 mm in width and 0.3 mm in length. Proximally the dissection was in the media but distally it lay at the medial-adventitial interface. There was no evidence of cystic medial necrosis but the muscle and elastic tissue of the media had a disorganized arrangement.