









































A 51-year-old man was admitted to hospital on the basis of dysarthria, left-side facial paralysis, pharyngitis, proximal 
loss of vision, left-arm paresis, and asphyxiation. Through various neurological testing, the patient was confirmed 
to have an ischemic stroke caused by an arterial dissection with a subintimal hematoma in the area of the carotid 
artery (carotid dissection). The patient was released from the hospital 3 days after being admitted with post-incident 
treatment instructions to ensure recovery.

In this case study, detailed clinical assessments, radiological findings, and therapeutic interventions will be reviewed 
to provide a holistic understanding of the patient's journey from injury to recovery. Through a meticulous analysis of 
real-life patient care, this thesis aims to help highlight the early symptoms of strokes and their impact on individuals, 
particularly those in physically demanding and dangerous work conditions, such as the patient, who worked as a 
roofer. By shedding light on the unique challenges faced by individuals in such occupations, I seek to contribute 
to the growing body of knowledge in stroke medicine. Ultimately, the goal is to improve clinical management and 
outcomes for individuals affected by carotid dissection while advocating for safer working conditions for those at 
risk.

Keywords: Psychology, Psychobiology, Evolutionary Studies, Honors, Neuroscience, Neurology, Carotid Dissection, 
Stroke, Medicine, Work Conditions

Aisthesis      Volume 16,  202518

Carotid Dissection: A Stroke of Insight into Safer Work 
Conditions

by Natalia Turkiewicz

 A dissection is characterized as “a tear of the inner 
layer of the wall of an artery” (Carotid Dissection, 
n.d.). A dissection can occur to the carotid artery, 
known as a “carotid artery dissection.” The carotid 
is a major artery that carries blood from the heart to 
the head. There are two of them, one on each side of 
the neck (each splits into two branches) (Definition 
of Carotid Artery - NCI Dictionary of Cancer Terms,  
n.d.). This condition, characterized by tearing of the 
inner lining of the carotid artery, causes blood to get 
into the layers of the artery walls and separates them, 
causing blood flow to the brain to stop. Such an order 
of events can activate the body’s clotting system, by 
leaking blood into the arterial wall, decreasing blood 
flow and increasing the risk of a stroke (Campellone 
et al., 2023). This can cause a transient ischemic 
attack (TIA) or stroke (Carotid Dissection, n.d.). The 
condition is caused by extraneous strain on the neck 
area, either through car accident, intense exercise, 
or heavy lifting (Evbayekha et al., 2023). In certain 
cases, carotid artery dissection can heal on its own, 

but other times it leads to compromised blood flow 
to the brain. It is a significant medical concern 
with the potential to cause a stroke. While carotid 
dissection can occur in various demographics, 
certain occupations, particularly those involving 
physically demanding tasks, may harbor unique risk 
factors predisposing individuals to this condition. 
 In construction, where workers often engage 
in strenuous activities such as lifting heavy objects, 
bending, and overextending, the potential for 
carotid artery dissection may be heightened, yet 
remains unexplored. This is a facet that warrants 
further investigation. By delving into this aspect of 
occupational health, we can gain valuable insights 
into individuals' unique challenges in physically 
demanding professions and implement targeted 
preventive measures to mitigate the risk of vascular 
complications.
 In this paper, I aim to explore the intersection 
between construction work and carotid artery 
dissection, shedding light on the potential 



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  202519

occupational risk factors and the need for further 
research in this domain. By identifying and 
addressing these occupational hazards, we can strive 
to promote the health and safety of construction 
workers while advancing our understanding of 
vascular health in physically demanding professions.

Case Presentation
 In this examination, a 51-year-old married 
individual and occupational roofer in the 
construction industry suffered from a carotid 
dissection. The patient was admitted to the hospital 
on March 19, 2019. The patient is 6 feet tall and 
weighs two hundred fifteen pounds. The individual 
currently resides in Brooklyn, New York. 
 On February 18, 2019, the patient suffered from 
an incident at work. He was working with roofing 
rubber, an extremely heavy roofing material, taking 
one roll at a time to the area that needed attention. 
At a certain point he went to pick another one up. It 
seemed as though this one was heavier. Consequently, 
he yanked on it with extreme exacerbation. 
Afterwards, he noticed they were stuck together. 
This exacerbation caused him to strain his neck and 
was likely the cause of the carotid dissection. 
 Indeed, the day of the incident, he began to 
experience a feeling of pharyngitis1 and episodes of 
asphyxiation.2 These symptoms localized to the left 
neck area proximal to the clavicle, with exacerbation 
noted during eating and drinking. Conversely, the 
pain experienced by the patient was slightly relieved 
through resting, although it never fully diminished. 
These symptoms lasted the entire time until the 
patient was hospitalized, with increasing discomfort 
daily. The day before being admitted to the hospital, 
March 18, 2019, the patient began to experience 
facial paralysis on the left side, as well as, left arm 
paresis.3 The next day, March 19, 2019, the patient 
began to experience temporal hemianopia4 and 

1 Pharyngitis = sore throat
2 Asphyxiation = choking
3 Paresis = weakness leading to the continuous dropping 
of objects
4 Temporal hemianopia = loss of peripheral vision in one 
eye

dysarthria.5 The onset of these symptoms caused the 
patient to call an ambulance, and ultimately led to 
his hospitalization.
 The patient had a past medical history of 
hypertension.6 His mother also had hypertension. 
His father died from a myocardial infarction.7 His 
brother had a brain aneurysm and suffers from 
epilepsy.8  
 To understand the patient's lifestyle, detailed 
information was compiled to shed light on critical 
aspects of his daily routine. Understanding the 
patient's alcohol history, the initiation of alcohol 
consumption dates back to his 18th birthday. 
Presently, the patient engages in social drinking, 
primarily at gatherings occurring approximately 
once a month. Turning to the smoking history, the 
patient stated he is a former smoker. He used to 
smoke a pack of cigarettes daily for twenty years, 
starting on his 19th birthday, but after 20 years he quit, 
and presently does not smoke. In terms of exercise, 
the patient's occupation was extremely physically 
demanding. His physical activity involved work six 
times a week, in 10-hour work shifts. His exertions 
predominantly revolved around the challenging 
tasks associated with roofing, encompassing roof 
repair, replacement, and installation with materials 
of substantial weight, such as metal, aluminum, 
wood, shingles, tiles, slate, steel, cement, and clay. 
The patient has an inconsistent amount of sleep, 
depending on where he is working at the time; 
however, he tries to get approximately seven (7) 
hours per night. 

Considerations
 Upon the patient's admission to the hospital, 
the healthcare team had to assess the patient's 
symptoms thoroughly to consider potential 
differential diagnoses. The observed clinical 
manifestations prompted the exploration of several 
plausible scenarios. Given the patient's occupation 
as a roofer and the incident at work, the primary 

5 Dysarthria = slurred speech
6 Hypertension = high blood pressure
7 Myocardial infarction = heart attack
8 Epilepsy = brain disorder causing repeated seizures



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  202520

hypothesis was an ischemic stroke.9 The neurological 
symptoms, including dysarthria, facial paralysis, and 
temporal hemianopia, aligned with this possibility 
and necessitated a comprehensive examination of 
vascular factors. The possibility of a hemorrhagic 
stroke10 was also contemplated, given the abrupt 
onset of certain symptoms and the nature of the 
patient's work involving physical exertion. This 
hypothesis warranted a meticulous examination of 
imaging studies to discern any signs of bleeding. 
Additionally, the patient's profile and symptoms 
raised the possibility of a cerebral aneurysm,11  
particularly with the reported asphyxiation episodes. 
Further imaging and neurovascular assessments 
were imperative to ascertain or dismiss this potential 
diagnosis. A final hypothesis was a myocardial 
infarction, given the patient's family history, age, and 
the presence of symptoms such as dysarthria and left 
arm paresis. This differential diagnosis framework 
guided the subsequent investigations, allowing for 
a systematic approach to unraveling the underlying 
cause of the patient's symptoms. 

Final Diagnosis
 One laboratory exam and five neuroimaging 
techniques were used to make the patient's final 
diagnosis—chest x-ray, CT scan, CTA, MRI, MRA, 
and lipid panel. All diagnostic tool images and values 
were analyzed by the physician. All patient images 
provided in the case study were obtained from the 
patients’ records with permission from the patient. 
 The chest x-ray that was deemed normal as it 
showed no focal consolidation,12 pleural effusion,13 
pneumothorax,14 or radiographic evidence of acute 
intrathoracic15 abnormality (Figure 1). 

9 Ischemic stroke = blood supply to part of the brain is 
blocked 
10 Hemorrhagic stroke = a blood vessel in the brain leaks 
causing bleeding in the brain
11 Cerebral aneurysm = a weak spot on an artery that 
balloons and fills with blood
12 Focal consolidation = when air in the airways of the 
lungs is replaced with a different material
13 Pleural effusion = accumulation of fluid in the pleural 
cavity
14 Pneumothorax = collection of air within the pleural 
cavity (outside the lung)
15 Intrathoracic = in the thorax

Figure 1: Chest X-Ray16 

Note. The image on the top is an example of a normal 
Chest X-ray. The image was borrowed from (Chest X-Ray 
- Basic Interpretation, n.d.). The image on the bottom is 
the patient's chest x-ray that was also deemed normal. 

 The CT scan showed no loss of gray-white matter, 
as well as no acute intracranial17 hemorrhage18  or 
extra-axial19 collection (Figure 2). There was no 
midline shift, hydrocephalus,20 or herniation.21 

16 See Appendix A for more details
17 Intracranial = within the skull 
18 Hemorrhage = bleeding from a blood vessel
19 Extra-axial = lesions that are external to the functional 
brain tissue
20 Hydrocephalus = buildup of fluid in ventricles within 
the brain causing increases in the size of the head
21 Herniation = something inside the skull produces pres-
sure that moves brain tissues



Historical Redlining Practices

Aisthesis      Volume 16,  202521

However, there was mild prominence of ventricles, 
and the sulci reflected age-appropriate volume loss. 

Figure 2: Computerized Tomography (CT)22 

Note. The image on the top is an example of a normal CT 
scan. The image was borrowed from Hacking (2015). The 
image on the bottom is the patient's CT scan showing 
mild prominence of ventricles as well as age-appropriate 
sulci’s volume loss. 

 The CTA showed no hemodynamically23  
significant stenosis24 or aneurysm (Figure 3). The 

22 See Appendix A for more details
23 Hemodynamically = relating to the mechanics of 
blood circulation
24 Stenosis = narrowing

bilateral common carotid, right internal carotid 
artery, and vertebral arteries were patent without 
hemodynamically significant stenosis. However, 
there were calcifications/tonsillitis of the palatine 
tonsils, as well as multilevel discogenic25  degenerative 
changes of the cervical spine, most pronounced at 
C4-C5 and C5-C6, where there is likely mild canal 
and mild-to-moderate bilateral neural foraminal 
stenosis. Additionally, there were mild calcifications 
along the aortic arch, and the origins of the vertebral 
and common carotid arteries were patent. There was 
a fibrofatty plaque at the carotid bulbs bilaterally,26  
with severe luminal narrowing of the left cervical 
internal carotid artery. The narrowing had a diameter 
of approximately 1.2 mm, beginning about 1.5 cm 
from the bifurcation27 to the skull base.  

Figure 3: Computerized Tomography Angiography 
(CTA)28 

25 Discogenic = degenerative changes such as structural 
defects that result in instability/inflammation between 
the vertebral bodies
26 Bilaterally = both sides
27 Bifurcation = the area where something divides into 
two branches
28 See Appendix A for more details



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  202522

Note. The first image (on the previous page) is an example 
of a normal CTA scan. The image was borrowed from 
Cuete (n.d.). The second image is the patient's CTA scan. 
The arrow in the image points to a minimal luminal 
narrowing with a string-like appearance of approximately 
1.2 mm in the left internal carotid artery beginning about 
1.5 cm from the bifurcation to the skull base. 

 The MRI showed no acute infarction, 
intracranial hemorrhage, mass effect, herniation, 
or extra-axial collection (Figure 4). There was, 
however, prominence of the ventricles and sulci that 
was consistent with minimal diffuse parenchymal 
volume loss. A few punctate foci of T2 hyperintensity 
in the periventricular and subcortical29 white matter 
likely represents minimal chronic microvascular 
ischemic change. T1, T2, and fat-suppressed T2 
FLAIR imaging of the distal cervical left internal 
carotid artery demonstrate findings consistent with 
arterial dissection with subintimal hematoma. 

Figure 4: Magnetic Resonance Imaging30 

Note. The image on the left is an example of a normal MRI. 
The image was borrowed from Hazell & Ainali (2023). 
The image on the right is the patient's MRI scan.  

29 Subcortical = nerve centers below the cerebral cortex
30 See Appendix A for more details

 The MRA reflects that there is long segment 
severe stenosis of the cervical portion of the left 
internal carotid artery with T1 hyperintensity 
in the false lumen consistent with subintimal 
hematoma and a diagnosis of arterial dissection 
with severe luminal stenosis (Figure 5). There was a 
diminishment of flow-related signal in the petrous 
and hollow portions of the left internal carotid 
artery, suggesting a component of collateral flow 
from the circle of willis31 with some retrograde flow 
into the cavernous left internal carotid artery. There 
is a slightly diminished flow-related signal in the left 
middle cerebral artery and its proximal branches but 
no focal significant stenosis or occlusion.32 

Figure 5: Magnetic Resonance Angiography33 

Note. The top row is an MRA of the head. The image 
on the left is an example of a normal MRA of the head. 
The image was borrowed from Magnetic Resonance 
Angiography (MRA) Is an MRI of the Blood Vessels (n.d.). 
The two images on the right are the patient's MRA scan of 
the head. The bottom row is an MRA of the blood vessels. 
The image on the left is an example of a normal MRA of 
the blood vessels. The image was borrowed from Burtea 
(n.d.). The two images on the right are the patient's MRA 
scan of the blood vessels. The arrows in the images localize 
the long segment in the left internal carotid artery that 
has severe stenosis, confirming a diagnosis of an arterial 
dissection. It also localizes the diminishment of flow-
related signal, suggesting collateral flow from the Circle 
of Willis with some retrograde flow into the cavernous left 
internal carotid artery. 

 The imaging techniques used suggest that the 
patient suffered from an ischemic stroke caused by 
an arterial dissection with a subintimal hematoma in 
the area of the carotid artery (carotid dissection).

31 Circle of willis = ring of vessels connecting the anterior 
and posterior circulations of the brain
32 Occlusion = the blockage of a blood vessel
33 See Appendix A for more details



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  202523

 After the diagnosis was confirmed, a lipid profile 
was conducted to help determine how best to treat 
the patient during their stay at the hospital (Figure 
6). The patient's results showed normal levels of 
total cholesterol,34 triglycerides,35 and HDL ratio.36  
However, they also showed elevated levels of low-
density lipoprotein37 (LDL)38  and lowered levels of 
high-density lipoprotein39 (HDL).40 The lipid profile 
results suggest an elevated amount of harmful lipids, 
which helps to best establish a treatment plan for 
the patient. The patient had to be put on clopidogrel 
bisulfate and Atorvastatin to help monitor the high 
amount of LDL found in the lipid profile and help 
stop blood clots. 

Figure 6: Lipid Profile41 

Note. The image above is the patient’s lipid profile. All 
normal values are indicated under “standard range” for 
reference. 

34 The desirable amount is <200 mg/dL. The borderline 
high amount is 200-239 mg/dL. The high amount >=240 
mg/dL.
35 The normal value is <150 mg/dL. The borderline high 
amount is 150-199 mg/dL. The increased amount is 200-
499 mg/dL. The very high amount is >=500 mg/dL.
36 The desirable amount is 4.0. The Borderline is 5.0. 
High-risk is 6.0.
37 Low-density lipoprotein = bad cholesterol that is a 
significant contributor to clogged arteries
38 The desirable amount is between <100 mg/dL. The 
above optimal amount is 100-129 mg/dL.  The Borderline 
High-Risk is between 130-159 mg/dL. The high risk is 
between 160 and 189 mg/dL. The Very High Risk is >=190 
mg/dL
39 High-density lipoprotein = good cholesterol that helps 
protect against heart disease
40 The low HDL Cholesterol (major risk factor) value is 
<40 mg/dL. The high HDL (negative risk factor) amount 
is >=60 mg/dL.
41 See Appendix A for more details

 Overall, these findings were consistent with the 
symptoms, which reflected a weaker left side, mostly 
in the upper extremities, as well as loss of proximal 
vision in the left eye caused by the severe restriction of 
blood flow. The patient’s clinical symptoms correlate 
with compromised perfusion in regions supplied 
by the left internal carotid artery. The left middle 
cerebral artery (MCA) supplies key areas involved 
in motor control of the face and upper extremities 
and Broca’s area in the dominant hemisphere, which 
is essential for speech production. The diminished 
flow-related signal seen is consistent with the patient’s 
speech difficulties and left-sided motor deficits. The 
patient had suffered from a hematoma in the internal 
carotid artery, which restricted blood flow entirely 
by way of movement and, therefore, caused a blood 
clot.  
 Carotid artery dissection often involves a 
sequence of events in which mechanical strain 
leads to a tear in the arterial wall, particularly in 
areas already weakened by atherosclerotic plaque 
accumulation. These cholesterol-rich plaques 
contribute to endothelial injury, initiating a cascade 
of inflammatory responses and promoting blood 
coagulation. In this case, the arterial dissection 
and resulting subintimal hematoma compromised 
blood flow, ultimately causing an ischemic stroke. 
The body's hemostatic response, while essential 
for stopping bleeding, exacerbated the situation by 
forming intravascular clots that occluded cerebral 
circulation. 

Treatment
 The patient was in the Intensive Care Unit (ICU) 
for 3 days, the entire period of hospitalization. There, 
the patient received comprehensive monitoring and 
therapeutic interventions. As part of the in-hospital 
therapy regimen, the patient underwent targeted 
speech therapy sessions aimed at addressing and 
ameliorating neurological deficits, particularly 
dysarthria resulting from the stroke. Additionally, 
the patient was being consistently monitored for his 
vital signs, including body temperature, pulse rate, 
respiration rate, and blood pressure. Furthermore, 
regular monitoring of blood glucose levels was 
conducted. Given the nature of the patient's 
condition, monitoring of neurological deterioration 
was prioritized, allowing for early detection of any 



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  2025

concerning changes in neurological function and 
facilitating prompt intervention as needed.
 The patient received a variety of IV medications 
to address the patient's condition. One crucial 
component was using sodium chloride 0.9%, 
commonly known as normal saline.42 The patient 
received a 5ml flush injection intravenously every 
eight hours to ensure adequate hydration and 
circulation. The adverse effects of normal saline 
include, but are not limited to, hypernatremia, 
fluid retention, high blood pressure, electrolyte 
abnormalities, and injection site reactions. 
 Additionally, the patient received Alteplase,43  
marketed under the brand name Activase. The 
adverse effects of this drug include but are not limited 
to nausea, vomiting, dizziness, mild fever, and 
allergic reactions (swelling, rash, hives). The patient 
received a 0.9 mg/kg dose (not to exceed 90 mg total 
dose), with 10% of the total dose administered as 
an initial intravenous bolus over 1 minute and the 
remainder infused over 60 minutes.
 The last IV medication the patient received was 
Heparin,44 a type of antithrombotic, to inhibit platelet 
aggregation and thrombosis. Its adverse effects 
include but are not limited to Heparin-induced 
thrombocytopenia, hematoma, hemorrhage,45 
erythema,46 and anaphylaxis.47 The patient's initial 
dosage was given an IV bolus of 60 units/kg (max: 
4000 units). Then, it was given at a dosage of 12 
units/kg/hr (max 1000 units/hr) as continuous IV 
infusion.
 The patient was also prescribed a variety of 
tablet medications. The first, Clopidogrel Bisulfate,48  
is commonly known as Plavix. Clopidogrel has a 
similar use in the patient's medication regimen, 
essentially functioning to inhibit platelet aggregation 
and thrombosis. The dosage prescribed was 75 mg by 
mouth once daily, with the treatment plan involving 
a transition to platelet monotherapy in three weeks, 
as determined by the neurologist during the follow-
up visit. Adverse effects associated with Clopidogrel 

42 See Appendix B for more details
43 See Appendix B for more details
44 See Appendix B for more details
45 Hemorrhage = bleeding
46 Erythema = skin redness
47 Anaphylaxis = allergic reaction
48 See Appendix B for more details.

Bisulfate include upper respiratory tract infection, 
angina, influenza syndrome, arthralgia, and 
depression.
 Additionally, Atorvastatin,49 under the brand 
name Lipitor, was included in the patient's medication 
regimen to regulate cholesterol homeostasis, reduce 
plaque progression, manage lipid levels, and reduce 
the risk of cardiovascular events. The prescribed 
dosage was an 80 mg tablet of Atorvastatin once 
daily, with continuous refills as recommended by 
the neurologist. Adverse effects associated with 
Atorvastatin include swelling of hands, ankles, or 
feet, insomnia, muscle cramps, trouble breathing, 
and pancreatitis.
 These medications, administered in conjunction 
with other components of the treatment plan, 
exemplify the comprehensive approach to addressing 
the patient's condition by targeting different aspects 
of stroke pathology, including volume restoration, 
thrombus dissolution, and anticoagulation; the 
treatment regimen aimed to optimize patient 
outcomes while mitigating potential risks. All of the 
medications given play pivotal roles in managing the 
patient's condition and reducing the risk of recurrent 
cardiovascular events. With the administration of 
medications, there was close monitoring of vitals 
and adverse effects. Additionally, regular follow-up 
assessments were recommended to ensure the safety 
and efficacy of the treatment regimen. The treatment 
plan aims to optimize the patient's long-term 
cardiovascular health and reduce the likelihood of 
future complications by addressing the underlying 
pathophysiology and associated risk factors.

Outcome and Follow-Up
 A stroke caused by a carotid artery dissection 
is rare and best managed by an interprofessional 
team that includes a neurologist, emergency 
department physician, radiologist, vascular surgeon, 
and an internist. The patient needs to be educated 
about blood pressure control, as the recurrence of 
dissection has been reported in up to 10% of cases 
and the patient already suffers from high blood 
pressure. This means that there is a 75% chance that 
the patient will suffer from another stroke caused by 
a carotid dissection.
 Upon the patient's discharge from the hospital, 
arrangements were made for comprehensive 

49  See Appendix B for more details.

24



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  2025

follow-up visits to ensure ongoing monitoring 
and management of his condition. These visits 
were scheduled with an ophthalmic and general 
neurologist to provide specialized care tailored to 
the patient's needs. The follow-up examinations 
were designed to encompass various diagnostic 
assessments to evaluate multiple aspects of the 
patient's health status and treatment response. 
Diagnostic imaging of the optic nerve of the eye was 
ordered to assess for any structural abnormalities 
or changes indicative of optic nerve involvement 
related to the stroke. 
 In addition, specialized tests were conducted 
to evaluate the patient's response to antiplatelet 
therapy, including assessments of platelet resistance 
to medications such as Plavix (Clopidogrel) and 
aspirin. These tests were essential for gauging the 
efficacy of the prescribed medicines in preventing 
clot formation and minimizing the risk of recurrent 
vascular events.
 Furthermore, a follow up lipid profile was ordered 
to assess the patient's lipid levels and cardiovascular 
risk factors, providing valuable information for 
optimizing lipid-lowering therapy and reducing the 
risk of future cardiovascular events. Non-invasive 
imaging studies were scheduled as well to assess the 
later vascular status of the head and neck, including 
M.R. angiography without IV contrast. 
 The patient's ongoing care was optimized by 
coordinating these follow-up visits and examinations 
with a multidisciplinary team of specialists, including 
ophthalmic and general neurologists, ensuring 
thorough evaluation and targeted intervention to 
promote recovery and minimize the risk of recurrent 
stroke.

Discussion
 While the clinical findings align with common 
presentations of carotid artery dissection (including 
unilateral facial paralysis, dysarthria, and 
hemiparesis), this case is notable for the prolonged 
period between the initial injury and hospitalization, 
as well as the specific occupational trigger—a forceful 
neck strain while roofing. 
 As there is a limited amount of research done 
on the connection between work-related efforts 
and carotid dissection, the case of the patient, a 
roofer, underscores the critical need for a nuanced 
understanding of the early symptoms of strokes, 

particularly within the context of physically 
demanding and hazardous work conditions. 
Roofing, characterized by strenuous labor and 
exposure to challenging environments, represents 
a profession where the potential impact of a stroke 
can be profoundly magnified. This discussion aims 
to shed light on individuals' distinctive challenges 
in such occupations, emphasizing the importance 
of early symptom recognition to enhance clinical 
management and outcomes for those affected by 
carotid dissection.
 Early symptoms of strokes often manifest subtly, 
making their identification challenging, especially 
in physically demanding work settings. In the case 
of the roofer, the initial signs, including pharyngitis 
and episodes of asphyxiation, were subtle and easily 
attributed to general illness. The later symptoms, 
such as left arm paresis and facial paralysis on the 
left side, seemed to be caused by the physical strain 
of the job, simply being attributed to physical 
exhaustion. The demanding nature of roofing may 
contribute to delayed recognition of neurological 
symptoms, as individuals may dismiss initial signs as 
consequences of their labor-intensive activities. This 
delay in identification poses a significant obstacle 
to timely medical intervention, which is crucial for 
mitigating the consequences of a stroke.
 To improve clinical management and outcomes 
for individuals affected by carotid dissection in 
physically demanding professions, there is a need for 
heightened awareness and education. Occupational 
health programs should incorporate specific 
training on recognizing early symptoms of strokes, 
emphasizing the importance of seeking prompt 
medical attention. 
 A variety of changes can be implemented in order 
to minimize the risk of those in physically demanding 
jobs. These changes overall include improving the 
safety protocols and procedures. This can be done 
through providing comprehensive training on safe 
work practices and hazard recognition, as well as 
introducing equipment or techniques that reduce 
physical strain, such as mechanical lifts for heavy 
materials, ergonomic tools, or assistive devices to 
minimize manual lifting and carrying. Additionally, 
ensuring adequate rest and breaks can help to prevent 
fatigue and overexertion, both of which contribute 
to strokes. Workers should have sufficient time to 
rest and recover by either minimizing shift hours, 

25



Carotid Dissection: A Stroke of Insight into Safer Work Conditions

Aisthesis      Volume 16,  2025

allowing for more breaks, or allowing for flexible 
work arrangements with more time off, such as job 
rotations between workers. As such, regular health 
screenings and assessments should be mandated 
for workers, allowing for timely intervention and 
preventive measures. Finally, due to the excessive 
amount of physical strain, workers in physically 
demanding jobs should have an earlier retirement 
age to prevent illness caused by a combination of 
old age and physical strain. By implementing these 
changes, employers can create safer and healthier 
work environments that prioritize the well-being of 
workers and reduce the risk of injuries and health 
complications, specifically with an emphasis on 
strokes.
 Advocacy for safer working conditions is 
paramount and requires the collaboration of 
healthcare professionals, employers, and regular 
civilians. Through collaborative efforts, we can pave 
the way for safer working conditions and enhanced 
well-being for those at risk in physically demanding 
professions.

Appendix A (Diagnostic Tools)
 This appendix aims to provide more in-depth 
information on the diagnostic tools used in the 
evaluation and diagnosis of this carotid artery 
dissection.

Chest X-Ray
 A chest x-ray utilizes a projection radiograph to 
diagnose conditions that affect the chest/thoracic 
cavity. It displays nearby structures and the details of 
the internal chest. This is done with a small amount of 
radiation and computed tomography that produces 
images of the heart, blood vessels, airways, lungs, 
and the bones in the chest and spine area. A sizable 
movable x-ray machine is attached to a large metal 
arm. The movable x-ray is moved to various angles 
to capture pictures from different perspectives. The 
patient should take a deep breath and hold it for 
several seconds. This will help the patient's heart and 
lungs appear more clearly in the image. On a healthy 
chest x-ray, we see a large amount of the image is 
radiolucent,50 showing air in the lungs. Structures 
that block radiation appear radiopaque.51 In an 

50 Radiolucent = dark 
51 Radiopaque = light

abnormal x-ray, there will be fluid in or around the 
lungs, heart, or air surrounding a lung. 

Computerized Tomography (CT)
 A CT scan uses x-rays to create an image of 
an area in the body using a series of pictures from 
different angles. Together, these various images 
create a cross-sectional image of an area or structure 
within the body. CT scans are often used in acute 
neurological emergencies and trauma cases because 
they are quick to administer. During a CT scan, 
the patient lies in a tunnel-like machine while the 
inside rotates, taking a series of images from various 
angles. These constructed images are then sent to a 
computer. There, the images are combined to create 
detailed cross-sectional images of different areas/
structures. They may also be connected to produce a 
3-D image of a particular body area. 

Computerized Tomography Angiography (CTA)
 A CTA looks explicitly at the vessels of the brain 
to detect any abnormalities or blockages. Like a CT 
scan, a CTA uses a computer to take images via 
x-ray; however, for a CTA, vascular access must be 
established to inject an IV contrast. This is done to 
provide a clearer image of the arteries. 

Magnetic Resonance Imaging (MRI)
 Magnetic Resonance Imaging (MRI) produces 
high-resolution images of organs and other structures 
in the body using radio waves and magnets. It is a 
form of medical imaging that uses nuclear magnetic 
resonance. This means that it takes images of the 
nuclei of atoms within the body. In an MRI, radio 
waves are reflected by fat and water within the body. 
These reflections are then collected and recorded by a 
computer. The MRI machine translates the collected 
data into a detailed image that is then used to assess 
the area being examined.

Magnetic Resonance Angiography (MRA)
 Like an MRI, an MRA uses nuclear magnetic 
resonance. However, an MRA specifically uses 
hydrogen-created radiofrequency signals that 
travel through the arteries to create images. Then, 
a computer removes images of other structures, 
making the image of the arteries clearer. Like a CTA, 
vascular access must be established to inject an IV 
contrast. The laser beam localized is centered over 
the glabella.  

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Aisthesis      Volume 16,  2025

Lipid Profile
 A lipid profile measures the amount of fatty 
substances found in the body's cells through the 
collection of blood. It is done through the collection 
of blood through a 21-gauge needle connected to an 
SST tube (also known as a plasma separator tube). 
After collection, the plasma is separated from the cells 
by being centrifuged for a minimum of 10 minutes 
and then the sample is refrigerated until it will be 
analyzed. A lipid profile provides the physician with 
the total cholesterol, triglyceride, HDL, LDL, and 
cholesterol ratio values. 

Appendix B (Medications) 
 This appendix aims to provide more in-depth 
information on the medications used to treat this 
carotid artery dissection.

Sodium Chloride 0.9%
 Sodium Chloride 0.9%, also known as normal 
saline, is an aqueous solution of electrolytes52 
and other hydrophilic53 molecules. Normal saline 
functions to expand intravascular volume without 
disturbing ion concentration. 

Alteplase 
 Alteplase, also known as Activase, is a tissue clot 
buster. Thrombolytic drugs such as clot busters are 
given to patients who are having an ischemic stroke. 
It can stop a stroke by breaking up the clot. It must be 
given within 4.5 hours after stroke symptoms start, 
and receiving it can reduce the severity of a stroke 
and reverse some of the effects, ensuring a speedy 
recovery. 

Heparin
 Heparin is an anticoagulant/thrombolytic agent 
that is injectable. It stops the formation of blood clots 
by blocking the action of clot-promoting proteins in 
the blood. 

Clopidogrel Bisulfate
 Clopidogrel Bisulfate is an antiplatelet drug that 
inhibits the ability of platelets to clump together. 
“Drugs that inhibit platelet function have been 
shown to decrease morbid events in people with 
established cardiovascular atherosclerotic disease” 
(Plogryl Product Clinical Pharmacology, n.d.) 

52 Electrolytes = ions that dissociate in solution
53 Hydrophilic = strong affinity for water

Atorvastatin
 Atorvastatin is an HMG-CoA reductase inhibitor, 
also known as a statin, meaning that it works to lower 
cholesterol. As such, it is used together with “diet, 
weight loss, and exercise to reduce the risk of heart 
attack and stroke” (Adivast [Atorvastatin Calcium],  
n.d.) to decrease the amount of fatty substances and 
triglycerides in the blood and increases the amount 
of good cholesterol (Lipicure -Why Is This Medication 
Prescribed?, n.d.). This is because accumulation of 
cholesterol and fats along the walls of the arteries 
(atherosclerosis) decreases blood flow. With this in 
mind, atorvastatin works to slow the production of 
cholesterol in the body that may build up on the walls 
of the arteries and block blood flow. “Lowering…
blood level of cholesterol and fats with Atorvastatin 
has been shown to prevent heart disease, angina 
(chest pain), strokes, and heart attacks” (Lipicure - 
Why Is This Medication Prescribed?, n.d.). 

Acknowledgements
 I would like to express my heartfelt gratitude to 
all those who have contributed to the completion 
of this case study on carotid artery dissection, a 
topic that holds personal significance to me due 
to its impact on my family. Firstly, I am grateful to 
my father, who has shared with me his experience 
of having a stroke caused by carotid dissection. His 
unique case served as the impetus for this paper. His 
resilience, courage, and determination throughout 
his recovery journey has been a constant source 
of inspiration, driving me to delve deeper into 
understanding this complex medical condition, as 
well as its implications for individuals working in 
physically demanding professions.
 I extend my appreciation to the healthcare 
professionals who provided care to my father during 
his recovery. Furthermore, I would also like to 
acknowledge the support and encouragement of my 
academic advisors, Professor Giordana Grossi and 
Dr. Thomas Nolen, whose guidance and mentorship 
have been instrumental in shaping this case study. 
Their expertise has challenged me to strive for 
excellence and to push the boundaries of knowledge 
in pursuit of scientific inquiry.
 Together, the collective efforts of these individuals 
have culminated in the completion of this case study, 
which I hope will contribute to the broader body of 
knowledge surrounding carotid artery dissection 

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Aisthesis      Volume 16,  2025

and, ultimately, improve the lives of those affected by 
this condition.

Author’s Disclosure
 This case report is based on the firsthand 
clinical experience of my father, who provided 
informed consent for the sharing of his medical 
history, imaging, and treatment details. The case was 
documented using personal interviews and access 
to the patient’s hospital records, obtained with full 
permission and in accordance with ethical research 
practices. This case reflects a real and medically 
verified diagnosis of carotid artery dissection. The 
intent is to offer a patient-centered perspective on 
stroke diagnosis and treatment, with the goal of 
highlighting occupational risk factors and improving 
awareness of early symptom recognition in physically 
demanding professions.

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