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Course: Pulsatile Superficial Temporal Artery: A Sign of Carotid Dissection With Stroke

CME Credits: 1.00

Released: 2022-02-14

A 41-year-old man with hypertension developed pulsatile tinnitus in his left ear, a left-sided retro-orbital headache, and blurred vision 3 days after cracking his neck to relieve stress from aviation work. His wife noticed a swollen blood vessel on the left side of his head and took a photograph on her cell phone (A) of his acutely engorged and pulsatile left superficial temporal artery (STA). She brought him to the hospital, where his blood pressure was 112/63 mm Hg and magnetic resonance angiography (MRA) revealed an acute left internal carotid artery (ICA) dissection (A). On fat-suppression sequences of the MRA, a semilunar hyperintense signal indicated an ICA intramural hematoma. Diffusion-weighted magnetic resonance imaging (MRI) demonstrated multiple small acute infarcts within the anterior circulation territory of the ipsilateral hemisphere (B). The appearance and distribution of the strokes indicated embolization from the ICA dissection. He was given therapeutic anticoagulation with intravenous heparin. Hours later, his STA was no longer bulging; it had soon normalized in size and pulsatility and appeared unremarkable on a follow-up photograph (B) at that time.


Educational Objective
To identify the key insights or developments described in this article


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