A Case of Triple Spontaneous Cervical Artery Dissection in an Atypical Patient: Evolving Symptoms and Prognosis of Multiple Cervical Artery Dissections
Timothy Bauer1, Yakov Isakov2
1Neurology, Nuvance Health, 2Neurology, Vassar Brothers Medical Center
Objective:
To present a case of three spontaneous cervical artery dissections and discuss the implications on patient outcomes.
Background:
Cervical Artery Dissections (CeADs) are cervical artery wall tears that are uncommon causes of Ischemic Stroke overall but are more common sources in younger patients or those with specific risk factors, such as neck trauma, chiropractic manipulation, or connective tissue disorders. They typically present as single artery dissections, but rarely present as double dissections (13-23%) or triple/quadruple dissections (2-4%). There is minimal data comparing risk factors or outcomes of patients with single dissections versus multiple dissections.
Results:
A 71-year-old female presents with 18 hours of progressively worsening right leg weakness, right lower facial droop, and mild right arm/leg numbness. CTA head/neck identifies nonocclusive 1.4cm left internal carotid dissection, nonocclusive 0.7cm right internal carotid dissection, and nonocclusive short segment left vertebral dissection. She denies any neck trauma, chiropractic manipulation, or personal/family history of connective tissue disorders. Her symptoms worsened to full right hemiplegia within hours and MRI brain showed acute ischemic infarction of the left corona radiata. Review of imaging shows ectasias with presumptively causative diagnosis of Fibromuscular Dysplasia. Unfortunately, the patient remained hemiplegic upon discharge to rehab.
Conclusions:
This case highlights an atypical patient presenting with three spontaneous CeADs and Acute Ischemic Stroke, found to have Fibromuscular Dysplasia. Atypical features include older age than typical for Fibromuscular Dysplasia dissections, slowly progressing symptoms, and multiple dissections on presentation.
The literature is sparse for differences in long-term outcomes between single versus multiple dissections, but this case suggests that patients with Fibromuscular Dysplasia who present with multiple dissections, present later in life, or have more slowly developing symptoms could be at increased risk for worse functional outcomes. More research is needed to better individualize treatment of Cervical Artery Dissections and improve outcomes.
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