Simultaneous multiple cervical vessel dissection manifested as pulsatile tinnitus

A previously healthy 43-year-old woman with Wallenberg syndrome, stemming from a left vertebral artery dissection and resulting in a left lateral medulla oblongata infarct, was later diagnosed with simultaneous bi-carotid and right V3 dissection. Seven days post-admission, she experienced sudden right-sided pulsatile tinnitus and exhibited a right-sided carotid murmur. High-resolution vessel wall MR imaging confirmed the new dissections. While spontaneous cervical vessel dissections involving more than two arteries are rare (less than 2% of cases), the prognosis is generally favorable. This case is noteworthy for presenting pulsatile tinnitus as a rare post-stroke dissection recurrence symptom, as documented in medical literature.