Spontaneous bilateral internal carotid artery dissection with acute stroke in young patients.

We studied the clinical and neuroradiological features of 41 cases with spontaneous bilateral internal carotid artery dissection (ICAD), including 3 cases in our hospital and 38 retrieved from the English literature. Bilateral ICAD accounts for 15.8% of young stroke patients with ICAD in our hospital. The most common presentations are head and/or neck pain, cerebral ischemia, carotid bruit and Horner's syndrome. The cerebral ischemic symptoms are extremely variable in bilateral ICAD, including unilateral hemisphere, bilateral hemisphere or brainstem-like symptoms. Although the underlying pathogenesis remains uncertain, good vascular and clinical outcomes are achieved for spontaneous bilateral ICAD.