Objective:

To describe an uncommon presentation of neck pain, transient perivascular inflammation of the carotid artery (TIPIC), mimicking carotid dissection.

Background:

Transient perivascular inflammation of the carotid artery (TIPIC) is a rare cause of unilateral neck pain characterized by vascular inflammation and circumferential thickening of the carotid wall, typically at the distal common carotid or bifurcation. Diagnosis is made on clinical and radiological grounds.

Design/Methods:

N/A

Results:

A 28-year-old healthy male presented with stabbing severe right neck pain for six days, beginning abruptly after waking. The pain was localized under the right mandibular angle, worsened with leftward head tilting, and radiated to the right ear. He denied headaches, visual changes, neurological deficits, recent trauma, chiropractic manipulation, or illness. CTA of the head and neck showed mild luminal irregularity along the posterior wall of the right cervical internal carotid artery, with mural hypodensity and soft tissue changes concerning for a carotid dissection. He was admitted to the neurology service and started on anticoagulation.  MRI and MRA revealed eccentric wall thickening and luminal irregularity, concerning TIPIC. MRI neck soft tissue showed enhancing, eccentric thickening of the right distal common carotid artery extending to the proximal ICA with T2 fat-sat hyperintensity, suggesting an infectious/inflammatory etiology, with TIPIC as the leading differential. Vasculitis was considered less likely due to the isolated asymmetric appearance and the lack of clinical features. Anticoagulation was discontinued, anti-inflammatory treatment was started, and symptoms resolved within 15 days.

Conclusions:

TIPIC syndrome is a self-limited or anti-inflammatory responsive condition presenting as acute unilateral neck pain and can radiologically mimic carotid dissection. Recognizing its benign nature and absence of neurological insults may prevent unnecessary anticoagulation.