Spontaneous improvement of idiopathic intracranial carotid artery dissection: A case report

We report a rare case of spontaneous intracranial carotid artery dissection presenting with multiple infarctions. A 65-year-old man became aware of transient visual disturbance in the right eye and headache. Magnetic resonance imaging (MRD at a local neurosurgical clinic depicted fresh multiple infarctions of the right cerebral hemisphere along with severe right carotid artery stenosis and delayed cerebral blood flow on the right side. The patient was transferred to our hospital- Three-dimensional computed tomography (3D-CT) showed an intimal flap in the right petrous internal carotid artery and we diagnosed spontaneous intracranial carotid artery dissection of the petrous portion. We started conservative therapy including anti-coagulant and antiplatelet drug and blood pressure control. Two weeks after admission, angiography, 3D-CT, MR angiography demonstrated that the dissection had improved and the patient was discharged without neurological deficit. In this case, 3D-CT was effective for the diagnosis of intracranial carotid artery dissection. We report this rare case along with a literature review of the clinical profile and related neuroimaging findings.