To the Editor.
—Spontaneous dissection of the internal carotid artery is becoming the subject of more and more clinical reports.1 As yet, there appears to be no consensus concerning the prognosis of these lesions or the most appropriate course of management (eg, medical, surgical, nonintervention).2 In his recent article in the Archives, Bogousslavsky and coworkers3 have painted a rather gloomy clinical picture in association with these lesions, but, based on the material presented in their article, several questions arise. We are told that all cases included in this report suffered occlusions of the cervical internal carotid artery as determined by angiography. This criterion for inclusion is somewhat surprising given the general view that carotid occlusion is found in a minority of patients suffering spontaneous dissection of the internal carotid artery.4 Also surprising is the high figure cited for distal embolic intracranial branch occlusion (seven of 19
Kushner M. Spontaneous Dissection of the Internal Carotid Artery. Arch Neurol. 1988;45(2):138. doi:10.1001/archneur.1988.00520260024006
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