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(Stroke. 1995;26:480-483.)
© 1995 American Heart Association, Inc.

Articles

Stroke Due to Recurrent Ipsilateral Carotid Artery Dissection in a Young Adult

Larry B. Goldstein, MD; Linda Gray, MD Christine M. Hulette, MD

From the Departments of Medicine (Neurology) (L.B.G.), Radiology (L.G.), and Pathology (C.M.H.) and the Center for Health Policy Research and Education (L.B.G.), Duke University; and Durham Department of Veterans Affairs Medical Center (L.B.G.), Durham, NC.

Correspondence to Larry B. Goldstein, MD, Box 3651, Duke University Medical Center, Durham, NC 27710.

Background Extracranial carotid artery dissection is a well-recognized cause of ischemic stroke. Recurrent carotid artery dissections are infrequent. Recurrent ipsilateral dissection has only rarely been documented and has not been pathologically verified.

Case Description A 33-year-old woman presented with a left parieto-occipital ischemic stroke. Angiography demonstrated a pseudoaneurysm of the extracranial left internal carotid artery. There was no angiographic evidence of an underlying vasculopathy. The pseudoaneurysm was resected, and microscopic examination revealed features most consistent with fibromuscular dysplasia with areas of both chronic and recent dissection.

Conclusions This case suggests that the frequency of fibromuscular dysplasia as a cause for "idiopathic" spontaneous carotid artery dissection may be higher than previously recognized and that recurrent embolization may occur in the setting of chronic dissection due to redissection of the previously involved vessel.

Key Words: carotid arteries • cerebrovascular disorders • dissection • fibromuscular dysplasia • young adults

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