Objective:

Describe the clinical presentation of quadruple cervical artery dissection (CeAD) and situate this rare entity within the literature

Background:

CeAD causes ~25% of ischemic strokes in adults <50 years. Its etiology is multifactorial, including environmental triggers, genetic predisposition, and anatomical vulnerability. Concurrent triple-/quadruple-vessel CeADs are rare(≈2–4%), and existing guidelines offer limited clinical approach. The 2024 AHA Scientific Statement updated CeAD recommendations but does not explicitly address multiple simultaneous dissections, underscoring the need for further awareness

Design/Methods:

Systematic review of English-language studies in MEDLINE/PubMed (1977–January 2024) using terms “multiple cervical artery dissections,” “triple cervical artery dissection,” and “quadruple cervical artery dissection.” Of 505 unique records, only two described quadruple CeAD. We report a case of quadruple CeAD with extension to the aortic arch

Results:

A 33-year-old woman with prior left MCA infarct from left ICA dissection(post–cervical manipulation) remained asymptomatic on aspirin 81 mg daily for seven years. She developed brief right-eye blurring with headache while driving, without trauma. CTA showed tapered right ICA occlusion consistent with dissection; MRI showed no acute infarct, and stroke workup was otherwise unrevealing except LDL 145 mg/dL. She was started on heparin and transitioned to apixaban 5 mg twice daily. Forty-eight hours later, after a sneeze, she had transient left-hand numbness. Repeat CTA revealed new dissections of the aortic arch/left subclavian artery, bilateral vertebral arteries, and left upper-cervical ICA. Neuroendovascular stenting of the right vertebral artery and left ICA was performed. She was discharged neurologically intact on aspirin plus clopidogrel with stroke and genetics follow-up

Conclusions:

Simultaneous triple-/quadruple-vessel CeAD may lack extensive symptoms and can progress despite initial medical therapy. To our knowledge, this is the first reported case of simultaneous quadruple CeAD with extension to the aortic arch and subclavian artery. Multidisciplinary approach and establishing a registry of multivessel dissections are essential to better define factors influencing their occurrence