Abstract
We report a case of cervical carotid artery dissection that recurred twice in other cervical vessels. A 37-year-old female developed headache after twisting her neck while playing tennis. Angiography revealed occlusion of the left cervical internal carotid artery (cICA) and MRI showed left cerebral infarction and intramural hematoma of the left cICA. Based on these findings, left cICA dissection was diagnosed. After hospitalization, we initiated bed rest and medical therapy. After 14 days, repeated MRI/MRA showed recanalization of the left cICA and dissection of the left cervical vertebral artery (cVA). We continued conservative therapy and she was discharged from the hospital about a month later with no sequelae. Repeated angiography after 5 months showed complete resolution of both dissections. At 6 months after the first admission, she developed dizziness with slight headache, and radiographies revealed right cICA dissection. Recurrence of spontaneous ICA dissection is not very rare, but two recurrences are rare, especially if re-dissections occurs sequentially in the cervical ICA and cVA. The pathogenesis of spontaneous cervical artery dissection is unclear. From the present case, we proposed that the first minor neck injury was related to the dissections because the three dissections occurred at similar cervical levels.
