Headache, TIA and subarachnoid haemorrhage: Dissecting an unusual cause for stroke-like symptoms

Elliot T. Dawson, Desmond A. Brown, Alejandro A. Rabinstein

Research output: Contribution to journalArticle

Abstract

We present a case of supraclinoid internal carotid artery dissection. Eleven months prior, the patient developed isolated periorbital pain and was diagnosed with giant-cell arteritis with iritis. The patient experienced recurrent spells concerning for transient ischaemic attacks and was transferred to our institution for endovascular intervention after head CT revealed an embolic infarct with a 'dense middle cerebral artery sign.' Digital subtraction angiography was negative for occlusion, instead demonstrating luminal stenosis and poststenotic dilatation. He subsequently experienced acute neurological decline secondary to massive subarachnoid haemorrhage. Non-invasive vascular imaging revealed an intimal flap and a pseudoaneurysm at the site of luminal stenosis, confirming our suspicion for intracranial carotid artery dissection. Given the moribund clinical state, the family opted to withdraw care, and he quickly expired.

Original languageEnglish (US)
Article number219927
JournalBMJ case reports
Volume2017
DOIs
StatePublished - 2017

Keywords

  • Headache (including Migraines)
  • Neuroimaging
  • Neurosurgery
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)

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