2023 American Academy of Neurology Abstract Website

Objective:

To evaluate the risk of stroke with common carotid artery(CCA) dissection. We report a rare case of spontaneous and isolated CCA dissection presenting with small left middle cerebral artery(MCA) territory ischemic strokes.

Background:

Common Carotid artery dissection is a rare entity, that typically occurs in the setting of trauma, procedures, or the direct extension of an aortic dissection. Interestingly, isolated and spontaneous cases of CCA dissection, as in our case, are extremely rare.

Design/Methods:

N/A

Results:

A 78-year-old gentleman with a history of atherosclerotic risk factors, paroxysmal atrial fibrillation on apixaban, and two previous episodes of transient ischemic attacks (TIA) presented with right-sided numbness and weakness. On examination, the patient had a right upper extremity pronator drift and an NIHSS of 1.

Computed Tomography (CT)-Scan of the brain showed no acute intracranial abnormalities. However, Magnetic Resonance Imaging (MRI) revealed small left hemispheric infarcts in the MCA territory. CT-Angiography showed complete or near complete long segment occlusion of the left CCA shortly after its origin with a double lumen sign concerning for left CCA dissection complicated by complete left internal carotid artery (ICA) occlusion.

The patient was started on heparin drip for the initial 48 hours, which was then changed to apixaban, and was discharged on life-long apixaban and aspirin 81 mg daily for 3 months.

Conclusions:

Our patients' findings were indicative of an isolated CCA dissection that occurred spontaneously in the absence of trauma or neck manipulation, aortic dissection, or connective tissue disease. Our diagnosis was also supported by previous TIA episodes that occurred prior to the main ischemic event. It must be noted that a high index of suspicion is required to make a timely diagnosis, and the primary goal of treatment is to prevent the recurrence of ischemic events with anticoagulation or antiplatelet therapy. Optimal treatment strategies are yet to be determined.