[A case of spontaneous cervical carotid artery dissection]

We report a patient with spontaneous cervical internal carotid artery (ICA) dissection. A 46-year-old woman had experienced left neck pain for 10 days. One month later, she was admitted because of the sudden onset of right hemiparesis and left amaurosis, which lasted for 30 minutes. On hospital day 3, the patient experienced the sudden onset of right hemiparesis and total aphasia, which lasted for two weeks. A CT scan failed to reveal any abnormal findings. Cerebral angiograms showed irregular narrowing of the left internal carotid artery distal to the carotid sinus and extending to the base of the skull ("string sign"). Magnetic resonance imaging (MRI) revealed a high signal intensity crescent-shaped mass expanding the wall of the left ICA and narrowing its lumen. SPECT scans showed decreased cerebral blood flow in the left hemisphere. When the symptoms progressed despite-conservative therapy, surgery was performed (STA-MCA anastomosis). Many patients who develop spontaneous ICA dissection show recovery to normal arterial caliber angiographically 1 to 3 months after the onset. Thus, careful monitoring of the clinical course is important and in cases of impending stroke, surgery should be performed immediately.