Arterial Dissection

A year ago, I sustained an injury, the result of a freak accident, which caused the dissection of two arteries in my neck—the right carotid and the left vertebral arteries. In the subsequent 48 hours, this undiagnosed injury brought with it a frightening chance of stroke and death.

It all started when I bought a new bed and mattress. I thought I’d save some money by setting it up myself. My friend, Ken, had warned me to be careful. “They’re heavy,” he said, but I laughed and said “They aren’t even pointy. How could I hurt myself?” But when I dropped the mattress on my head, twisting my neck in the process, I had no idea I had caused the internal injury. At first I didn’t feel too bad. In fact, it wasn’t until 48 hours later that the headache began. That headache lasted a full month, getting progressively worse until I thought I had triggered a migraine. Unable to get in to see my Internist, I drove myself to the Urgent Care one night, desperate for relief. They diagnosed me with a migraine—after all I had a history—but it had been 10 years since I had had a full-blown migraine. That was the first heads up.

They treated me as though it was a migraine, and I went home and collapsed on my bed. My good kitty Frankie, lay on the bed next to me, and as I dozed and woke through the night, my head still pounding, I was briefly aware that he was there. By the morning the pain was even worse and I had begun vomiting. The pain had become so unbearable, I was having suicidal thoughts. I needed to escape the pain. I could not bear it. I lay on my back on the living room floor twisting in pain when I wasn’t hanging over the toilet retching. My father came and took me to the ER. I told them that I was hearing a strange noise with each throb of my head. A high-pitched squeal. Heads-up number two.

They treated me for a migraine again—this time with a cocktail of drugs. When the headache had gone from being off the charts to a “2” (on a scale from one to ten) they sent me home. I lay on the bed, again with Frankie beside me, half awake, if not asleep, for the next 48 hours. If Frankie left me, I never knew it. When I started to wake up, I found the headache still with me, only now it was bearable—still teeth-gritting bad, especially if I moved—but I could take it. It was a month before it fully resolved. But I still could hear the noise in my head. Tinnitus, it is called—a sound that no one else can hear. And while that is often a normal condition, especially as people age, the pulsatile nature of this was not. It required a medical work-up.

I went first to the hearing doctor. I described to him the high pitched squeal that I would sometimes mistake as a bird chirping outside the window--only then I would realize that it had been chirping too consistently and too long. I would laugh at myself, thinking, “oh, it’s that sound.” He tested my hearing. Normal, and he was concerned. He ordered an MRI of my brain.

Then, days later, I got the call. The doctor told me I had a dissected carotid artery, a condition which he described as a tear in my artery. He told me to remain calm, do nothing strenuous, and not to eat or drink until he could a neurologist on the case to do further assessment. A torn carotid artery? That sounded like a death sentence to me. I called my best friend Ken. I needed him to be with me. I hoped he could get there in time. I called my ex-husband who was on his way out of town. I tearfully begged him to return home to my two boys, telling him of my condition, and saying “they might need you.” If I died, I wanted their father to be with them. And I drove to the house where my boys lived. I was afraid to turn my head for fear of bleeding to death, but I needed to get to them—to tell them myself—to see them again. In the driveway, I called my parents. They needed to know, and my boys would need them too, if things went badly.

I spent some time with my boys, then left for my house. Ken arrived, and by that night I was having more MRIs and was admitted to University Hospital. I spent a sleepless night with more imaging studies, and hourly checks on my neurological symptoms, and IVs of medicine to thin my blood with the hope of preventing a stroke. Finally, they explained to me, that a dissection is the inner layer of an artery that pulls away from the middle layer. That sounded better than what I had been imaging, but they cautioned me that the chance of death from it are significant due to the possibility of clots forming at the tear site and breaking away, and entering the brain. In the next days, they discovered a second dissected artery—this one the left vertebral.

What was happening to me? I was popping arteries right and left. As I lay in the hospital bed that night, I thought and thought—one was on the left, the other on the right. It must have been a twisting accident. The mattress, I realized.

In the coming days I was on IV drugs to thin my blood. Then I learned to give myself Lovenox injections in my belly. Intimidating at first, but I could do it. They sent me home and I had blood tests twice weekly to check my blood. Finally, I was switched to an oral medication. Six weeks later, at my follow-up visit with the neurologist, I learned several things. First, very little is actually known about arterial dissections. They happen most often in high impact accidents such as car wrecks. But some people have had them after something as gentle as yoga. Little is documented about the recovery process of these dissections. The injury in the vertebral artery appeared in the MRIs to be further healed than the carotid. But the doctor admitted that is was entirely possible that the vertebral artery heals at a faster rate than the carotid too. Often, these arteries heal, closing back together, but at six months out, mine have not and likely will not. So for the rest of my life I will likely be on blood thinners—just as a precaution.

I have also decided that I should avoid any high impact activities when I can. With my arteries remaining dissected, I would not want them to dissect further upon impact. So I avoid ladders when I can, and learning to ice skate is probably not in the cards for me. But I feel good, the pulsitile tinnitus has gone away (it was caused by obstructed blood flow), and other than taking Plavix, life is as it used to be.

My take-away? If you 1) suffer a headache that is by far the worst you have ever had, 2) is worse than you have had in years, or 3) if it is in some way different than any other severe headaches you have had, you should probably see a doctor. My injury went undiagnosed through the most critical period, and I know I am lucky to be here.