Non-occlusive intracranial carotid artery dissection: transcervical carotid Doppler findings

Abstract

A 20-year-old man with no significant past medical history presented with sudden onset of sharp right temporal headache and left-sided weakness. He also noticed some visual disturbance in the left eye. His symptoms lasted about 6 h and then resolved. There was no history of recent trauma or drug abuse. There was a family history of stroke, which had affected his aunt and grandfather. He was normotensive and in sinus rhythm. Cardiovascular examination was normal and neurological examination confirmed a mild left-sided weakness and left facial droop. Unenhanced cranial CT and baseline blood tests were performed on the same day as the event and demonstrated no abnormality. Urgent carotid Doppler US on the following day showed normal Doppler parameters in the left extracranial carotid circulation. However, the right common carotid artery (RCCA) waveform demonstrated flow reversal in early diastole (Fig. 1(a)) when compared with the