Internal carotid artery dissection in a patient with Parkinson's disease after COVID-19 infection.

BACKGROUND

Internal carotid artery (ICA) dissection is a relatively rare cause of acute ischemic stroke. Stretching and compression of ICA due to sudden acceleration, deceleration, and rotational forces are risk factors for ICA dissection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to trigger an inflammatory response that exacerbates endothelial dysfunction and leads to arterial dissection. Although levodopa-induced cervical dyskinesia in Parkinson's disease often manifests as choreiform movement, dissection has not been reported in such patients.

CASE PRESENTATION: A 51-year-old man with Parkinson's disease (PD) presented with gradually worsening neck pain and transient aphasia 1 week after mild coronavirus disease 2019 (COVID-19) infection. The patient already had neck pain due to cervical spondylosis and presented with levodopa-induced cervical dyskinesia. Magnetic resonance imaging revealed acute ischemic stroke in the left parietal lobe and an intramural hematoma with an area of stenosis in the left ICA. The patient was diagnosed with left ICA dissection.

CONCLUSIONS

COVID-19 infection can cause vessel wall vulnerability. Although patients with PD often have neck pain, ICA dissection should be considered a differential diagnosis if the patient has a recent history of COVID-19.