Talk:Carotid artery dissection

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In October of 2004, 3 weeks before my 49th birthday, I was diagnosed with a left internal carotid artery dissection (LICAD). I am a nonsmoker, pretty active, and not overweight. I have a history of mild hypertensiveness, but overall prior to the diagnosis, my health has been great. I can count on one hand the times i've been to a doctor in the past twenty years.

Here is my story. It all started while I was at work when I noticed a mild headache at the top, slightly left of center part of my head. Not concerned I took two Tylenol. The headache lasted into the evening, at which point I decided to try two Motrin. The headache persisted when I finally went to bed. I was still not concerned figuring for sure the pain would be gone in the morning. I woke the next day for work, noticed no change, and became a bit more concerned. I am not a headache person and it seemed very odd that I had the exact same headache, in the same place after a night's rest. This headache, which I describe as a 2 out of 10 on the pain scale, went on for a week. Each day I became a little more concerned knowing that something wasn't right. My stress level increased each day and this made the headache worse.

It was a Saturday morning, a week now after the headache started, that I looked at my left eye in the mirror, and noticed a very slight droop in my lower left eyelid. Thinking I may have pinkeye, I asked my wife to take a look. She said, and I'll never forget the words, "I don't think you have pinkeye, but you know your pupils are two different sizes and that could mean a stroke" My wife's mother died two years earlier from a stroke and said she remembers seeing the same condition with her. At that point I became much more alarmed, and decided to skip going to a coworker's funeral to go to the ER. I needed answers and I couldn't rest. They gave me a CAT scan, drew some blood, and said I appear to have a sinus headache. I had sinus problems most of my life and felt the diagnosis may be right, however I was skeptical. Relieved that the ER found nothing remarkable, I was released with some sinus headache meds, and a recommendation to followup with an opthamologist and neurologist. Two days later I saw the opthamologist who said my eyes and vision were healthy, but I may have a condition called Horners eye syndorme. Now, with a not-so-concerning opthamologist and ER report, I again felt a sense of relief, and although not terribly concerned, I knew something was still wrong in my head, and this is not a good place to have a problem. I called my wife at work and told her the report and mentioned the term "Horners eye syndrome" (HES) My wife, who works for a medical company, said she'd try find info on HES. Neither of us ever heard of the term, but it didn't sound that frightening. It wasn't till that evening when my wife brought home the medical literature, that I would learn how deadly serious a Horners eye can be. That is when I first learned of the term, "carotid artery dissection (CAD)" and the symptoms that go along with it which included a HES. One symptom in particular, the inability to sweat on the side of the CAD, was confirmed when I decided to jog. I typically jog two or three times a week, and decided to test the sweating symptom through self diagnosis.

It was in disbelief, I did not sweat on my left side. After a two mile jog, my right side forehead was dripping wet, and the left side was bone dry. I had a very difficult time coming to terms with this very odd condition, and I became very, very alarmed and afraid. This condition never went away and to this day, 25 months after being released from the hospital, I think of it every time I sweat. It makes you feel like your broken. Through out this I was trying to make an appointment with a neurologist asap, when I finally found one that would take me the next day. The first two I checked said they couldn't see me for two to three weeks. I was determined, and my situation consumed every waking moment of my day. By this time the headache had expanded to my eye. The pain was described as feeling like a "toothache behind my eye"

I finally saw the neurologist who, looking back now, done an excellent job in confirming the diagnosis and getting me into Hanamenn Univeristy Hospital in Philadelphia. After giving me a full neurological exam, reviewing the opthamologist's report, and hearing me explain my symptoms, he sent me for an MRI, stat. He said a Horners eye can be very serious if the underlying condition is CAD, but that he didn't think I had CAD because I didn't complain of neck pain, nor suffered any apparent neck trauma. However he said he wanted to rule out it out. I was scheduled for the MRI at 2pm on a Friday The neurologist said if I don't here back from him by around 5pm my problem wasn't serious. After the MRI I went home, lied on the couch and waited anxiously to see if the doctor would call. At this point part of me wanted him to call, which would mean they finally found out what my problem is, and part of me hoped he wouldn't call.

At was about 3:30pm and the phone rang; I answered it as my heart pounded with anxiety. It was my wife calling to see if the doctor called. Slightly relieved, I said no, talked for a few seconds and hung up. I returned to the couch, and after another 30 minutes elapsed I finally dozed off thinking the doctor wasn't going to call and my condition wasn't serious. The phone rang at 4:15pm. Knowing this was the inevitable bad news, my heart pounding even harder with anxiety, I answered the phone. Sure enough it was the doctor. After exchanging hellos I cut to the chase and asked "this can't be good news, what's is wrong with me?" He said, and I'll never forget the words and the stern tone "you have a carotid artery dissection, and you'll need to go to the hospital immediately". He said I'll need to get someone else to drive me and to grab a pen to right down instructions. I was a mental mess. Looking for reassurance I asked what was going to happen and if I was going to be OK. He said I had a very astute wife noticing the pupil difference, and I am very lucky I hadn't stroked out. He said the hospital would probably put me on Heparin and may implant a stent, and that I should be fine. I then called my wife who work, told her to come home immediately, and take me to the hospital. She started to panic and said she'd call Jason, my stepson who is an EMT and try to get an ambulance to take me. We felt that would be the quickest way to the hospital. By this time it was Friday, 5pm and rush hour traffic was in full swing. I was very familiar with the traffic and knew this would be a horrowing night I would never forget.

The ambulance finally arrived about 5:30pm and the trip to the hospital was as bad as it could get. The ambulance broke down 3 times and it took 30 minutes to go just 4 of the 25 mile hospital trip. The decision was then made to transfer me to another ambulance. I thought I would never make it. When I finally arrived at the hospital I was surrounded by a great team of doctors. After many blood vials of blood were drawn and a battery of neurological tests, they finally admitted me about 1am. They put me on Heparin, and I felt like I was finally in good hands. Three days later they confirmed the CAD with an angiogram; two days after that I had two stents implanted in my left carotid.

Overall I was hospitalized for one week, and after being released spent a week at home recuperating. I take one plavix and one aspirin per day and 25 months later I'm feeling great. My first week back to work I had intense headaches mostly around my left eye. I thought I might have to go on disability, but over the course of a month they subsided. I guess this was my body healing after having my carotid being invaded by a foreign object. Since then I've dropped a needed 10 lbs, been going to the gym, and feel like I'm in the best shape I've been in for 20 years. Although I had a big scare about a month ago, with the return of headaches and another angiogram which ruled out re-dissection I am fine. The headaches, at least for now, are gone, however the slight eyelip droop and sweating problem never went away. I've come to accept the fact that I am getting older and my body will never be the same as it was prior to my diagnosis.

I thank God he has looked after me. Looking back it seems like a nightmare. Many times I thought I was going to have a stroke or even die. After reading other stories about CAD, I know I am luckier than many others. It is 25 months since the incident and although I've gained a new perspective of my life and mortality, I am overall doing very well. I would appreciate hearing from anyone else that has gone through this or a similar experience.

Bill