Emergency department presentation of bilateral carotid artery dissections in a postpartum patient.

Spontaneous unilateral postpartum carotid arterial dissection is a rarely reported event. This is the first reported case of bilateral carotid artery dissection. A 35-year-old gravida 4, para 3 woman presented to our emergency department with complaint of headache for 3 days. Medical history included delivery of a full-term infant by cesarean section 9 days before presentation because of arrest of descent after 3 hours of pushing. Symptoms were later attributed to a parietal lobe cerebral vascular accident and bilateral internal carotid artery dissection. Physicians should consider the possibility of arterial dissection in any postpartum patient with unremitting headache when evaluation of typical causes fails to lead to a diagnosis. Appropriate diagnostic evaluation and treatment should be actively pursued in this population.