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Cerebrovascular Disease

Pulsatile Superficial Temporal ArteryA Sign of Carotid Dissection With Stroke

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

1 Credit CME

JAMA Neurology

Published Online: February 14, 2022

Images in Neurology

Article Information and Disclosures

Karl A. Kasischke, MD¹;

David Z. Rose, MD²

Author Affiliations

¹Pioneer Neurohealth, AdventHealth Tampa, Tampa, Florida
²Department of Neurology, University of South Florida Morsani College of Medicine, Tampa General Hospital, Tampa

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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 (Figure 1A) 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 (Figure 2A). 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 (Figure 2B). 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 (Figure 1B) at that time.

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Article Information

Corresponding Author: Karl A. Kasischke, MD, Pioneer Neurohealth, AdventHealth Tampa, 13067 Telecom Pkwy N, Tampa, FL 33637 (kkasischke@pioneerhealthfl.org).

Published Online: February 14, 2022. doi:10.1001/jamaneurol.2021.5382

Conflict of Interest Disclosures: Dr Rose reported personal fees from Boehringer Ingelheim, Boston Scientific, Medtronic, CSL Behring, and Chiesi and grants from Bristol Myers Squibb/Pfizer outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

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Miteff F , Levi CR , Bateman GA , Spratt N , McElduff P , Parsons MW . The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain. 2009;132(8):2231-2238. doi:10.1093/brain/awp155 PubMed Google Scholar Crossref

Iwasawa E , Ichijo M , Ishibashi S , Yokota T . Acute development of collateral circulation and therapeutic prospects in ischemic stroke. Neural Regen Res. 2016;11(3):368-371. doi:10.4103/1673-5374.179033 PubMed Google Scholar

Myers DE , Boone SC , Gregg JM . Superficial temporal arterial dilation without headache in extracranial-intracranial bypass patients. Headache. 1982;22(3):118-121. doi:10.1111/j.1526-4610.1982.hed2203118.x PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.