Common Carotid Dissection

Patient 1 was a 58-year-old man who was brought to the emergency department after he collapsed in the kitchen. On arrival, the patient was comatose and did not react to pain stimuli. He was hypotensive (blood pressure 70/50 mm Hg), and ECG showed sinus tachycardia (120/min) with left bundle-branch block. Tests for troponin T were negative, and his D-dimer level was 3771 μg/L (normal range: 0 to 190 μg/L). Because of tachypnea and developing respiratory insufficiency, intubation became necessary. A massive pulmonary embolism was initially suspected.Patient 2 was a 47-year-old man who suddenly collapsed with aphasia, right-sided hemiparesis, and progressive loss of consciousness. After intubation and during transportation to the emergency department, he was hypertensive, but on arrival he became hypotensive (blood pressure 80/60 mm Hg). An ECG showed sinus tachycardia (127/min) and marked ST depression in V5 and V6. Tests for troponin T were negative, and his D-dimer level was 212 μg/L. Cerebral …