Bilateral common carotid artery dissection.

A 63-year-old Japanese man with no significant medical or family history was admitted for sudden consciousness disturbance, left hemiparesis and shock. Physical examination showed internal carotid artery asymmetry on palpation and significant differential blood pressure in both upper arms. A thoracic CT scan showed classic aortic dissection from the ascending aorta through the common iliac artery, classic dissection of the left common carotid artery and an intramural haematoma in the right common carotid artery. The patient's consciousness level gradually improved, and he underwent emergency surgery involving aortic rebuilding with a synthetic graft. Subsequently, he had a good clinical course.