Spontaneous carotid artery dissection: a rare cause of cerebrovascular accident

We present the case of a young woman who developed a cerebrovascular accident due to a spontaneous internal carotid artery dissection. We stress the importance of clinical clues to diagnosis: ipsilateral facial pain and a partial Horner's syndrome are the most frequent clinical manifestations. Compared to patients with atherosclerotic cerebrovascular disease, these patient are younger and typically do not have the classical cardiovascular risk factors. The diagnosis should be confirmed with duplex ultrasound and magnetic resonance imaging or computed tomographic angiography. In many cases, optimal therapy consists of 'watchful waiting' and prompt initiation of oral anticoagulants (during 3 to 6 months) and aspirin or clopidogrel in case of late presentation without ischaemic symptoms. Endovascular or surgical treatment is rarely needed. The overall prognosis is more benign compared to atherosclerotic cerebrovascular disease, although a somewhat elevated risk for recurrent dissection is observed.