Carotid artery dissections: symptoms, diagnosis and securing compensation for negligent treatment

Posted: 07/02/2025

Carotid artery dissections can occur following a neck injury or trauma, but equally after something as simple as coughing strenuously or taking a long phone call with your neck stretched in an awkward position. Penningtons Manches Cooper clinical negligence partner Alison Johnson examines the potential consequences if a medical professional fails to recognise or appropriately treat a patient showing signs of this condition and the factors that could contribute to a negligence claim.

Carotid artery dissection is a tear or separation in the layers of either of the two carotid arteries in the neck and can occur spontaneously or after a neck injury. The condition can heal itself over time but may cause life-threatening complications, including brain ischaemia (not enough blood bringing oxygen to the brain), subarachnoid haemorrhage (bleeding in the brain), stroke or a transient ischaemic attack (a mini stroke). 

Given the severity of the potential consequences of a carotid artery dissection, it is imperative that a diagnosis is made quickly, and treatment commenced to prevent further complications and in the worst-case scenario, to save lives. Carotid artery dissections can occur spontaneously, with few warning signs, but where there are symptoms, these usually include headache (often severe and long-lasting), facial pain, eye pain, neck pain, neurological issues such as memory problems, loss of balance, difficulty speaking and abnormal reflexes. They can also present in a similar fashion to strokes, with symptoms of sudden numbness or weakness, slurred speech or confusion. While carotid artery dissections can happen to anyone at any age, they are most common in people in their 40s or 50s.

Treatment of carotid artery dissections

Carotid artery dissections can be treated successfully, if diagnosed promptly and the required medical professionals and facilities are available. The first line of treatment may be anticoagulants, to break down blood clots and prevent new clots from forming. Antiplatelets can also help with preventing blood platelets from sticking together and forming blood clots. An angioplasty can be performed on the carotid artery to open it and stenting can keep it open. Finally, surgery can remove the dissection or reroute the blood flow around the dissection, but is usually considered a last resort. 

According to available medical information, the majority of people who experience a carotid artery dissection survive, with a mortality rate of less than 5%. Prompt medical intervention, including anticoagulation therapy, can significantly improve the chances of a positive long-term outcome.

Carotid artery dissections and negligence 

As carotid artery dissections can be difficult to diagnose, they may be missed in some instances, such as when performed in a busy and possibly frantic accident and emergency ward. To make a diagnosis and commence the right treatment in time, a careful physical examination is crucial.  Radiological imaging will be necessary in suspected cases, starting with an ultrasound of the neck, followed by a CT scan or MRI of the neck and/or brain. That imaging will be taken by a radiographer and considered and reported on by a radiologist. An angiography, an X-ray of a blood vessel, specifically of the carotid artery, will confirm the diagnosis. 

There may be several reasons behind the misdiagnosis of a carotid artery dissection. The examination undertaken may not be sufficiently thorough and key clues from a medical history can be missed, particularly important neurological ones. Headaches can be overlooked as something mundane and not given the significance they demand. A number of differential diagnoses may be considered, but the most potentially severe one, of a stroke or similar, may not be investigated initially leading to a failure to involve a neurology team quickly enough. This can be a particular problem when the patient reaches hospital during the night or at a weekend, when the medical team may be more junior and less experienced. Even after a diagnosis has been made, treatment may be delayed if there is not an experienced medical professional available out of hours or transfer is necessary to a larger hospital for surgery. 

Case study

A 41-year-old woman received £735,000 in damages for a left-sided paralysis sustained following the failure by her GP to make a referral for her to a neurologist in 2009. She suffered a stroke and was left with a very significant left hemiparesis, causing her to have a virtually useless left hand. She had visited her GP surgery as she had noticed a persistent headache and heaviness in her left arm which was probably a neurological symptom. Her GP diagnosed migraine and prescribed painkillers. The headaches persisted and the claimant experienced complete weakness in her left side with a numb lip and drooling. She saw the same GP again who this time suspected diabetes. 

Ten days later the claimant suffered a stroke with left sided paralysis. She was admitted to hospital where a CT scan confirmed an infarct on the right frontal lobe. She was then transferred to a second hospital where an MRI scan with contrast later that day indicated a right carotid artery dissection. The claimant was anticoagulated and commenced a long process of rehabilitation and recovery.

She brought a clinical negligence claim against her GP alleging that he was negligent in failing  to carry out an adequate examination of her; to take a proper history of her neurological symptoms; to consider the fact that she was continuing to complain of headaches despite having no history of migraines and the possibility of a stroke or transient ischaemic attack; to prescribe aspirin, heparin or similar medication; and to refer her to the stroke clinic or otherwise to a neurologist on an urgent basis. The defendant GP admitted liability and the claim was quantified and settled. 

Specialist support during stroke claims 

The clinical negligence team at Penningtons Manches Cooper, has experience in investigating neurological claims arising from strokes, including those caused by carotid artery dissections. We have represented many families where a loved one has survived a stroke and tragically, also where they have not. We investigate the circumstances of the medical treatment, looking at how and when the diagnosis was reached and treatment commenced, and crucially whether that was timely or not. 

We also look into the impact of any negligent medical treatment, being aware that the impact of a stroke can dramatically affect an individual's quality of life, as their mobility, speech, dexterity and cognitive abilities can be compromised. Their ability to work, to function independently and to convey their thoughts may be severely reduced while the drop in income and financial losses associated with such shocking and unexpected symptoms can be considerable. They may require personal care as well as care with normal everyday household chores and may no longer be able to drive. The impact on their family should also not be overlooked. 

Return to news headlines