Title : Multilocular extracranial arterial dissection with cerebral infarction in a young woman
Abstract:
Background: Extracranial cervical artery dissection is a significant cause of stroke in young patients without traditional cardiovascular risk factors; however, its clinical presentation is often nonspecific, which may delay timely diagnosis. This paper presents a clinical case of a young woman with multilocal extracranial arterial dissection complicated by cerebral infarction.
Case Presentation: We describe the clinical case of a 30-year-old woman who was admitted with a two-week history of headache and pulsatile tinnitus in the left ear, as well as transient numbness on the left side of the body. Neuroimaging (CT, CTA, and digital cerebral angiography) revealed a cerebral infarction in the territory of the left middle cerebral artery and multiple extracranial arterial dissections: occlusion of the left internal carotid artery due to dissection, dissection of the right internal carotid artery with approximately 50% luminal stenosis, and bilateral vertebral artery dissections. Neurological deficit was minimal (NIHSS 0, mRS 1).
Initial management was conservative, consisting of anticoagulant and antiplatelet therapy, due to a high perioperative risk. Follow-up CTA demonstrated recanalization of the left internal carotid artery with formation of a large dissecting aneurysm, prompting the decision for endovascular treatment. Percutaneous transluminal angioplasty with implantation of a flow-modulating stent was performed, resulting in restoration of the arterial lumen and near-occlusion of the dissecting aneurysm.
Conclusions: This case illustrates the complex course of multiple cervical artery dissections in a young patient with cerebral infarction. An individualized treatment strategy—beginning with conservative therapy and followed by selective endovascular intervention—allowed for a favorable clinical and radiological outcome. The case highlights the importance of a multidisciplinary approach and dynamic imaging follow-up in the management of such patients. Radiologists and neurologists should be aware of the possibility of arterial dissection in young individuals presenting with unexplained headache or tinnitus and consider appropriate diagnostic investigations and therapeutic strategies.
