Thyrotoxicosis and bilateral internal carotid artery dissections

Cervical artery dissection is a rare but important diagnosis to consider in young patients presenting with stroke. Multiple etiologies of cervical artery dissections have been previously reported, but the association with thyrotoxicosis is extremely rare. A previously healthy 43-year-old female presented to the emergency department with new symptoms related to thyrotoxicosis and bilateral internal carotid artery dissections. Her atrial fibrillation and hypertension resolved by treating the underlying hyperthyroidism with methimazole and propranolol. The bilateral internal carotid artery dissections were managed conservatively with acetylsalicylic acid. Despite an initially poor prognosis, the patient made a complete recovery with resolution of her neurological symptoms.