Carotid Dissection
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þ Etiology and Epidemiology
 - Age: For extracranial internal carotid artery dissection the mean age is 40
   years old.  For intracranial carotid artery dissections, the most common
   age of presentation is 20-30 years old.
 - The carotid artery is located just posterior to the tonsil. Therefore,
   children with an intra-oral foreign body (such as a lollipop) who fall face
   first may force the foreign body against the pharynx.  This can then injure
   the carotid artery and cause a carotid dissection.

þ Natural History and Associated Symptoms
 - 50% will develop Horner's syndrome (miosis, ptosis and facial anhydrosis)
   from compression of perivascular sympathetic trunks.
 - Cranial nerve palsies are found in > 10% of patients with extracranial
   carotid artery dissection. Palsy of a single or multiple cranial nerves is
   common with the following order of frequency: 12, 9, 10, 11, 5, 7, 6, 3.
 - Some may develop pulsatile tinnitus
 - May get a headache followed by a CVA (opposite of a regular ischemic CVA)