A Case Report of the Unusual Presentation of the Left and Then the Right Spontaneous Carotid Artery Dissections Within 3 Weeks and a 7-Year Follow-Up.

AIMS/BACKGROUND: Bilateral spontaneous carotid artery dissections are rare, comprising only 10% of spontaneous carotid artery dissection cases. They occur when there is a tear in the innermost lining of the artery called the tunica intima. An intramural hematoma may form which can lead to vessel lumen narrowing or occlusion, causing an acute ischaemic stroke.

CASE PRESENTATION: We present a case of a man in his 50s with bilateral spontaneous internal carotid artery dissection who presented with a sudden onset of headache, neck pain, and right arm weakness. After being treated, the patient presented again after 3 weeks with neck pain on the right side, headache, and transient left arm weakness. He was treated with anticoagulation followed by antiplatelet therapy.

RESULTS: At 6 months, the computed tomography angiogram (CTA) of carotid and vertebral arteries showed a largely resolved left internal carotid artery dissection (ICAD) and a resolved right ICAD. At the 7 years follow up, the patient continues to do well as he has not had any more transient ischaemic attacks or strokes.

CONCLUSION: This case demonstrates that carotid artery dissections should be considered when a patient presents with these symptoms, even if they present bilaterally in a short period, and can be investigated with a CTA or magnetic resonance angiogram, with treatment by antiplatelets or anticoagulation.