A Cause of Stroke in Younger People
You are too young to have a stroke. That is what you thought, and maybe what the doctor thought too. You came in with a bad headache, or neck pain, or a strange droopy eyelid, and you were sent home with pain medicine or a diagnosis of a pulled muscle or a migraine. Then came the stroke, in a person far too young for anyone to have expected it.
There is a hidden cause behind many strokes in younger and middle-aged adults, and it is often missed precisely because doctors are not looking for a stroke in someone that age. It is called a carotid artery dissection, and it is one of the most important misdiagnosed conditions in younger adults. It is a tear in the wall of one of the main arteries carrying blood to the brain, and it is one of the leading causes of stroke in people under 50. When its warning signs are recognized, a dissection can often be treated before a stroke happens. When they are missed, the result can be catastrophic.
This article explains the warning signs that a carotid artery dissection was missed, why it is so often overlooked, and what you can do next. If any of this sounds like your story, Lupetin & Unatin is here to help.
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Article written by Brendan Lupetin, Esq. Brendan is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
What a Carotid Artery Dissection Is
The carotid arteries run up each side of your neck and carry blood to your brain. A dissection happens when the inner lining of one of these arteries tears. Blood seeps into the wall of the artery, which can narrow or block the vessel and, dangerously, can form clots. Those clots can travel to the brain and cause a stroke.
A carotid dissection can happen after an obvious neck injury, like a car crash, but it can also happen after something surprisingly minor, a sudden turn of the head, a fall, heavy lifting, even vigorous coughing or a visit that involves neck manipulation. Sometimes it happens with no clear cause at all. Because the triggers can be so ordinary, and because the patient is often young, the diagnosis is easy to miss unless a doctor specifically thinks of it. The American Heart Association and American Stroke Association explain that clots blocking blood flow to the brain are a common cause of stroke, and a dissection is one way those clots form in younger people. The Cleveland Clinic describes the warning signs of a carotid dissection and why prompt treatment can prevent a stroke.
Why It Matters So Much in Younger Patients
Strokes are often thought of as a problem of old age. That assumption is exactly what makes a carotid dissection so dangerous. When a 35-year-old comes to an emergency room with a headache and neck pain, “stroke” may be the last thing on the doctor’s mind. But carotid and related artery dissections are a leading cause of stroke in younger and middle-aged adults. We have represented families after a young person’s brain clot was missed.
This is the trap. The very fact that the patient is young can cause a doctor to dismiss the warning signs, and to send home a person who is actually days or hours from a serious stroke. A careful doctor knows that a young patient with the right symptoms needs to be evaluated for a dissection, not reassured because of their age.
The Warning Signs That Should Not Be Missed
A carotid dissection often announces itself before it causes a stroke. The warning signs can include:
- A new, severe headache, often on one side, that is different from any headache the person has had before.
- Neck pain, often on one side.
- Pain around the eye or face on one side.
- A droopy eyelid and a smaller pupil on one side, part of a pattern doctors call Horner’s syndrome.
- A whooshing or pulsing sound in one ear.
- Brief stroke-like symptoms, such as temporary weakness, numbness, vision changes, or trouble speaking, which may signal a TIA.
- Vision problems, including temporary loss of vision in one eye.
The combination of a new one-sided headache or neck pain with any eye or neurological symptom, especially in a younger person, or after a neck injury or sudden movement, should make a doctor think of a dissection. These warning signs often appear days before a stroke, which is the window in which treatment can prevent disaster.
What Doctors Are Supposed to Do
When a carotid dissection is suspected, the path to diagnosis is well established. Proper care generally includes:
- Taking the history seriously, including any recent neck injury, sudden movement, or trauma.
- Recognizing the warning pattern, such as one-sided head or neck pain with eye or neurological symptoms.
- Ordering the right imaging of the blood vessels in the neck and head, such as a CT angiogram or MRI/MRA, which can show the tear. When that imaging is done but misread, it can be a radiology error.
- Starting treatment to prevent clots and stroke, often with blood thinners, once a dissection is found.
The key is that a doctor has to think of the diagnosis in the first place. The imaging that reveals a dissection is not usually part of a routine headache workup. It must be ordered because the doctor recognized the warning signs.
How a Carotid Dissection Gets Missed
A missed dissection almost always comes down to a doctor not considering it. Common failures include:
- Blaming the headache or neck pain on a migraine, tension, or a muscle strain without considering a dissection.
- Dismissing the patient because of their age, assuming a young person cannot be having a stroke.
- Failing to ask about, or act on, a recent neck injury or sudden neck movement.
- Overlooking telltale signs like a droopy eyelid and small pupil on one side.
- Not ordering vessel imaging when the warning signs were present.
- Treating brief stroke-like symptoms as unimportant because they resolved.
When these warning signs are missed, a treatable tear is left to form the clot that causes a stroke.
The Serious Harm a Missed Dissection Can Cause
When a carotid dissection is missed and a stroke follows, the harm can be life-altering, and especially tragic in a young person with decades of life ahead:
A major stroke, with lasting brain damage.
Paralysis or weakness, often on one side of the body.
Loss of speech and language.
Cognitive and memory problems.
Loss of independence and the ability to work and care for a family.
Death.
Because these patients are often young, the lifelong impact, and the cost of a lifetime of care, can be immense. For more on how strokes are missed and delayed generally, see our article on the delayed diagnosis and treatment of stroke.
When a Missed Dissection Is Malpractice
Not every missed dissection is malpractice. But when a patient presents with the warning signs, especially a new one-sided headache or neck pain with eye or neurological symptoms, or after a neck injury, and a doctor fails to consider a dissection or order the right imaging, that may fall below the standard of care, meaning what a reasonably careful doctor would have done.
To bring a claim in Pennsylvania, it must be shown both that the care was negligent and that the negligence caused harm, which is called causation. In a dissection case, that often means showing that timely imaging would have found the tear and that timely treatment, such as blood thinners, would have prevented the stroke. Because the warning window can be days long, the failure to act during that window can be central to the case.
These cases require review by qualified medical experts, and Pennsylvania requires a certificate of merit confirming that a professional believes the care fell short. An experienced firm handles these requirements.
What You Can Do Now
If you believe a carotid dissection was missed in you or someone you love, here are steps that can help.
- Get the complete medical records from the visit where the headache, neck pain, or other symptoms were evaluated, and from the later stroke.
- Write down the timeline, including any neck injury, fall, or sudden movement, and the order in which symptoms appeared.
- Note what was skipped, especially whether any imaging of the neck arteries was done.
- Do not blame yourself. You sought care. Considering a dissection was the doctor’s job.
- Talk to a lawyer who handles stroke cases, including strokes in younger patients.
The Time Limit to File in Pennsylvania
Pennsylvania generally gives you two years to file a medical malpractice claim, called the statute of limitations. Special rules can apply, including for cases involving a death, and for injuries to children, which are governed by a separate rule you can read about on our page explaining the minor’s tolling statute. Because deadlines are strict, it is important to act promptly. You can also read our statutes of limitations page.
How Lupetin & Unatin Can Help
We are Lupetin & Unatin, a Pittsburgh medical malpractice firm. We focus on serious injury and death from medical errors, including strokes that are missed because a treatable cause like a carotid dissection was overlooked.
We understand why dissections are missed, especially in younger patients, and how proper imaging and treatment can prevent a stroke. We work with medical experts to show what a careful doctor should have done, and how timely care would have changed the outcome. We know how these cases are defended, and we know how to prove them.
We take a small number of cases so we can give each one real attention. We work on a contingency fee. That means you pay nothing up front. You pay nothing unless we win. There is no cost to find out whether you have a case.
If you or someone you love suffered a stroke from a dissection that was missed, you deserve answers. You deserve to know whether it could have been prevented.
Call Lupetin & Unatin today for a free, confidential review of your case.
Frequently Asked Questions
Yes. Carotid and related artery dissections are a leading cause of stroke in younger and middle-aged adults. That is exactly why they are so often missed, because doctors may not expect a stroke in a young person. A careful doctor knows to consider a dissection when the warning signs are present, regardless of age.
It can be. Dissections sometimes follow obvious trauma like a car crash, but they can also follow minor events, a sudden head turn, a fall, heavy lifting, or vigorous coughing, and sometimes happen with no clear cause. What matters is whether the doctor recognized the warning signs and acted on them.
Vessel imaging of the neck and head, such as a CT angiogram or an MRI with MRA, can show the tear. This imaging is not part of a routine headache workup, so a doctor has to specifically suspect a dissection and order it. Failing to order it when the warning signs were present can be part of a malpractice claim.
Nothing up front. We work on a contingency fee, which means we are only paid if we win money for you. There is no fee to speak with us and no fee to review your case. We advance the costs of building the case, and if we do not recover for you, you owe us nothing.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.