A 40-year-old man was admitted to the Stroke Center, Bach Mai Hospital, on 10/9 with symptoms including facial droop and weakness on one side of his body. Doctors identified the direct cause of the stroke as carotid artery dissection in the neck, attributing it to a prolonged bent and twisted neck posture while sleeping during a long car journey.
Doctor Phung Dinh Tho, from the Stroke Center, explained that artery dissection occurs when the inner lining of a blood vessel wall tears, allowing blood to flow between the layers of the vessel wall and form a hematoma. This injury contributes to stroke through two mechanisms.
On one hand, the expanding hematoma can narrow or completely block the artery's lumen, reducing blood supply to the brain. On the other hand, the injured surface stimulates the formation of blood clots. These thrombi, if dislodged, can travel through the bloodstream to the brain, causing blockages in intracranial arteries.
Clinical statistics indicate that dissection of neck arteries – including carotid and vertebral arteries – accounts for approximately 25% of ischemic stroke cases in individuals under 50 years old. While this condition can occur spontaneously, it is largely associated with mechanical trauma or unusual pressure applied to the neck region.
Therefore, for stroke cases in younger individuals, doctors thoroughly review medical history for factors such as impact trauma, excessive neck movement, or prolonged maintenance of a bent or twisted neck posture.
Notably, carotid artery dissection often presents with localized warning signals before the onset of an ischemic stroke. Patients may experience sudden headaches or neck pain with an unfamiliar quality, distinct from any prior aches. Some cases have reported Horner's syndrome, characterized by mild eyelid drooping and a constricted pupil on the same side as the injury. Pulsatile tinnitus, which creates a sensation of a beating or "whooshing" sound in the ear synchronized with the heartbeat, is also an important indicator. When cerebral blood vessels become blocked, central nervous system symptoms rapidly emerge, including facial droop, paralysis or numbness on one side of the body, speech difficulties, and visual disturbances.
Doctor Tho advises that when traveling long distances or sleeping in vehicles, individuals should avoid maintaining their head and neck in excessively bent or twisted positions for many hours. People should absolutely not abruptly jerk or twist their neck joints. Should unusual headaches or neck pain occur, particularly after mechanical impact to the neck, accompanied by signs such as facial droop, limb weakness, or vision impairment, patients must immediately seek specialized stroke emergency medical care to access the "golden hour" for treatment.
Le Nga.
