The 8 week follow up from my consultant confirms the name of my stroke was an MCA stroke. This stands for Middle Cerebral Artery which means the sudden onset of focal neurologic deficit resulting from brain infarction or ischemia (restriction in blood flow) in the territory supplied by the MCA. The MCA is by far the largest cerebral artery and is the vessel most commonly affected by cerebrovascular accident.

Carotid Artery Dissection (CAD)

NB. I have taken bits of information to try to simplify and explain.

By definition this is a tear in one of your Carotid Arteries which are a set of 2 arteries at the sides of your neck.

They supply blood to your brain. A dissection is a separation of the layers of the artery supplying oxygen-bearing blood to the head and brain and is the most common cause of stroke in young adults, usually under the age of 50 and mid 40s or younger being a prime age.

A dissection does not necessarily cause a stroke. A person who has a dissection may suffer many symptoms, including; headaches, sore/stiff neck, impaired vision, loss of memory & asphasia (impairment of language, affecting speech & the ability to read and write). Usually, once diagnosed, these people are put on a blood thinner. The arteries can also become blocked. When a blockage occurs, that’s when there might be an increase in the risk of stroke because the clot can move or bits can break off.

If they become blocked, they either stay like that for a long time or they can become unblocked, usually over around 9 months with a blood thinner.

I asked on a couple of facebook support groups specifically about carotid artery dissection how many had suffered a stroke and how old they were. Not many replied compared to the amount of people on the groups but 66 people who did reply were between 16 and 57 years old.

So … How does a dissection occur?

Well … there are many ways a dissection can occur. I have taken bits of information from online.

There could be a natural weakness in the arteries, or family history meaning you are at higher risk, or a hyper extension of the neck. There are medical conditions which could also increase risk of a CAD as well;

• A long styloid process, a small part of bone near the jaw (Eagle syndrome, rare)
• Fibromuscular dysplasia
• Ehlers-Danlos syndrome
• Marfan syndrome
• Homocystinuria
• Alpha-1 antitrypsin deficiency
• Osteogenesis imperfecta
• Cystic medial necrosis of the aorta
• Segmental mediolytic arteriopathy
• Reticular fiber deficiency
• Reversible cerebral vasoconstriction syndrome
• Autosomal dominant polycystic kidney disease

A CAD can also have no known cause. This is when it is difficult for patients because they don’t know why it happened.

Again, from the group of people who responded on social media, there were a number of suggested diagnoses (I say suggested because there’s no definite answer unfortunately). Some of these are;

• Potentially a car accident (whiplash)
• Doing yoga
• Lifting something heavy
• A massage
• Visiting a chiropractor
• Doing weights
• Coughing
• Vomiting
• A virus

As you can see, frighteningly, these are every day activities or illnesses which I know I would never have thought in a million years would have caused or could cause a stroke.

My case …

I’ll start with the following quote taken from the write up of my 8 week follow up from my Neurologist at LGI;

I have explained that there are different categories of patients; ones that have genetic conditions that affect the connective tissue (making their vessels more fragile) such as Polycycstic Kidney, Ehler Danlos etc that she does not have, and other patients that unfortunately develop arterial dissections without any obvious risk factors or genetic predisposition. I think in her case her previous viral illness and physical activity was a potential trigger for this condition.

So, basically I was fit and healthy and just very unfortunate. I have said in earlier blogs that I was very ill over Christmas for about 3 weeks with what the doctor said was a bad viral chest infection and I’d had a very bad cough with it including some vomiting episodes from coughing too much. If you know me, you’ll also know that I tend to exercise to keep myself active and healthy and that it’s part of my job. Last year I actually didn’t do much of anything for myself, as I had gotten back into teaching fitness classes and that’s all I did.

I had no issues with my blood pressure or cholesterol, which can be other factors to increase the risk of stroke.

I was just unlucky that it happened to me, but very lucky that I’ve come out the other side and am able to make people aware of this condition as I’d never heard of it before.

I’m not sharing this to make people panic or worry that if they get a cough it may result in a CAD or if they suffer any of the medical conditions or do any of the activities listed as potential causes or have a virus that they’d have a CAD because plenty of people won’t.

The below gives you an idea of how many people per 100,000 may have a CAD.

The annual incidence of symptomatic spontaneous internal carotid artery dissection is 2.5-3 per 100,000. The incidence of carotid artery dissection as a result of blunt injuries (mainly high-speed motor vehicle accidents) ranges from less than 1% to 3%.

19th Feb 2019

Prognosis for me …

The surgery I had was successful, however, I had to have a stent fitted in my Right Carotid Artery.

The stent is 100% occluded (blocked). Unlike other patients who have a blocked or partially blocked artery which could heal, my stent will never change. It will just stay blocked and it’s very unlikely that my artery will ever heal. They won’t do more surgery because it’s too much of a risk. Obviously being that it’s one of the main arteries it’s a little bit of a worry, but the consultant assures me my blood just finds new pathways and it’s fine that it’s blocked. I think if I’d suffered symptoms i.e. headache/had sickness since the stroke, they would have tried something but luckily for me I haven’t. I am on blood thinners but after blood tests I don’t have “sticky blood” which means my levels for blood clotting is normal and not high – good news! I’m not allowed to do weight lifting due to the risk of increased BP. I’m very low risk of a stroke/CAD happening again in the future.

At some point the doctor is going to see me again as they have this new scanner that they can put on your head which can actually show how your blood is being carried around (which I think is pretty cool), and I’ll also have an MRI at some point which isn’t urgent but has been delayed with Covid.

If anyone ever does have any questions, please do send me a message to ask, or post in the comments and I’ll try and reply.

As always thank you for reading 🦋🦋🦋