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To the Editor.—
In the April 1977 issue of the Archives (34:251, 1977), Drs Roome and Aberfeld state in their article entitled "Spontaneous Dissecting Aneurysm of the Internal Carotid Artery" that there are "no distinctive clinical features" of the problem.Their clinical resume describes the patient as having "experienced sudden sharp pain in the left ear after blowing her nose." I have seen two unreported cases of spontaneous dissection of the internal carotid artery, and both patients complained of sudden, severe pain at the angle of the mandible and in the ear. This pain may represent a distinctive clinical feature.Both of these patients had transient ischemic episodes as a result of the dissection. One patient was operated on, did well for 24 hours, and then a dense hemiparesis developed secondary to another dissection that occurred at the site of surgical clamping. Immediate operation did not help her. She had
Mayer WB. Spontaneous Dissecting Aneurysm. Arch Neurol. 1977;34(8):517–518. doi:10.1001/archneur.1977.00500200077019
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