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Carotid artery dissection may occur in normal healthy vessels, as well as vessels weakened by primary arteriopathy, but is most common after trauma.1 The American Heart Association/American Stroke Association guidelines (2011) concluded that it is reasonable to treat extracranial carotid artery dissection with antithrombotic medication for at least 3–6 months.2 There is little information on endovascular stenting, but most clinicians agree that this should be used on a case-by-case basis.3
A 46-year-old man, previously well, presented to the emergency department with intermittent right arm and hand weakness, left eye visual loss and word-finding difficulty. An MR scan of brain with diffusion-weighted imaging was normal. A CT angiogram of the head and neck showed a left internal carotid artery dissection. Diffusion-weighted and perfusion imaging showed no increase in transit time …
Contributors All authors contributed equally to the writing of this manuscript and participated in the treatment of the patient.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by David Werring, London, UK.