Internal carotid artery dissection in a young healthy male patient.

PRESENTATION: A 41-year-old male patient presented to the emergency department (ED) with left sided headache, radiating to the left ear while also complaining of dizziness. A non-contrast CT brain, performed during a previous presentation five days earlier, was normal. On his second presentation, the patient displayed clinical signs of carotid artery dissection including left sided partial Horner's syndrome.

DIAGNOSIS: A CT Intracranial angiogram revealed a likely left internal carotid artery (ICA) dissection.

TREATMENT: The patient was commenced on dual antiplatelet therapy.

DISCUSSION: As the headache caused by dissection has no specific features, it can resemble that of cluster headache or migraine, which may mislead clinicians. However, the presence of ipsilateral neck pain or headache and a partial Horner's syndrome followed by retinal or cerebral ischaemic are indicative of carotid artery dissection. Due to the bleeding risks of anticoagulation versus antiplatelet therapy, an individualised therapeutic approach is recommended.