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 in frequent. Recurrent ipsilateral dissection has only rarely been docume nted and has not been pathologically verified. Case Description A 33-y ear-old woman presented with a left parieto-occipital ischemic stroke. Angiography demonstrated a pseudoaneurysm of the extracranial left in ternal carotid artery. There was no angiographic evidence of an underl ying vasculopathy. The pseudoaneurysm was resected, and microscopic ex amination revealed features most consistent with fibromuscular dysplas ia 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 highe r than previously recognized and that recurrent embolization may occur in the setting of chronic dissection due to redissection of the previ ously involved vessel.