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Updated: Jun 29, 2025

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
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Simultaneous multiple cervical vessel dissection manifested as pulsatile tinnitus.

George Nilton Nunes Mendes1, Laurent Letourneau-Guillon2,3, Yan Deschaintre1,4

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|March 27, 2024
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Summary
This summary is machine-generated.

This case highlights a rare instance of multiple cervical artery dissections, presenting pulsatile tinnitus as a unique symptom of stroke recurrence. The patient

Keywords:
Strokecervical dissectionthrombolysis

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Area of Science:

  • Neurology
  • Vascular Surgery
  • Radiology

Background:

  • Cervical artery dissection (CAD) is a leading cause of stroke in young adults.
  • Multiple spontaneous cervical artery dissections are uncommon, occurring in less than 2% of cases.
  • Wallenberg syndrome, resulting from a lateral medullary infarct, can be caused by vertebral artery dissection.

Purpose of the Study:

  • To report a rare case of simultaneous bi-carotid and right V3 dissection in a patient with prior Wallenberg syndrome.
  • To highlight pulsatile tinnitus as a potential, albeit rare, symptom of recurrent dissection post-stroke.
  • To emphasize the utility of high-resolution vessel wall MR imaging in diagnosing complex dissections.

Main Methods:

  • Case report of a 43-year-old female patient.
  • Review of clinical presentation, diagnostic imaging, and medical literature.
  • High-resolution vessel wall Magnetic Resonance (MR) imaging to confirm new dissections.

Main Results:

  • The patient presented with Wallenberg syndrome due to left vertebral artery dissection and subsequently developed simultaneous bi-carotid and right V3 dissection.
  • New dissections were confirmed by high-resolution vessel wall MR imaging.
  • The patient experienced new-onset right-sided pulsatile tinnitus and a right-sided carotid murmur.

Conclusions:

  • Simultaneous multi-artery cervical dissections, though rare, can occur and may have a generally favorable prognosis.
  • Pulsatile tinnitus can be an unusual presenting symptom of recurrent dissection following a stroke.
  • Vessel wall imaging is crucial for accurate diagnosis and management of complex cervical artery dissections.