Simultaneous, spontaneous and multivessel cervical artery dissection presenting with headache and vertigo

Cervical artery dissection (CAD) is a relatively common cause of stroke, particularly in young adults. Typical presentation includes headache, neck pain and neurological signs of ischaemic stroke. More than half of these cases are spontaneous, without a preceding history of trauma, and most commonly affect a single vessel. We report a case of a man in his 20s presenting with spontaneous, non-traumatic multivessel CAD (triple vessel, quadruple dissection), bilateral cerebellar infarcts and concomitant basilar artery thrombus. Triple or quadruple vessel CAD is seldom reported in the absence of trauma. Clinicians should be aware of CAD, and the extent to which it can occur, while appreciating the importance of good clinical examination and appropriate imaging in such cases. Correct characterisation of eye movements is key.