Stroke due to recurrent ipsilateral carotid artery dissection in a young adult

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.