[Recurrence of bilateral spontaneous cervical internal carotid artery dissection after a 12-year-interval: a case...

Recurrence of spontaneous cervical internal carotid artery (ICA) dissection is not rare (1%/year) but bilateral recurrence affecting the same cervical ICA is rare, especially after a 12-year-interval. A 41-year-old man exhibited left hemiparesis and angiography revealed tapered stenosis of his right cervical ICA. Within 2 days, his hemiparesis improved. After 21 days, repeated angiography showed complete resolution of the once-stenosed right cervical ICA. He was discharged with slight left hemiparesis. The follow-up angiography performed after 18 months disclosed not only the recanalization of the right cervical ICA but also a new concentric stenosis of his left cervical ICA. Since he presented no new neurological deficit, he was treated with an antiplatelet agent. The angiography performed 14 months later revealed normalization of bilateral cervical ICA. After 12 years, at the age of 53, he presented with worsening of his left motor weakness. Also on this occasion, angiography revealed bilateral cervical ICA dissection and their spontaneous resolution. The anamnesis revealed that he had experienced the same ischemic symptoms, that is, hemiparesis, aphasia and their spontaneous resolution, when he was 24 and 37 years of age. These 4 episodes had some characteristics in common: occurrence in winter (from December to March), being preceded by moderate fever and upper respiratory tract infection. The pathogenesis of spontaneous cervical ICA dissection is unclear. From experience with this patient, we propose that the occurrence of spontaneous cervical ICA dissection might depend on a genetic predisposition and infection might play the role of a trigger.