Pearls & Oy-sters: Unusual manifestations of bilateral carotid artery dissection

Abstract

A 44-year-old man in good general health presented with a 1-week history of deep-seated, moderate right eye pain without exacerbation on eye movement. Ophthalmologic examination showed visual acuity of 20/20 in both eyes, equal pupils with normal pupillary reflexes, mild right upper lid ptosis known to the patient for more than 5 years, and normal fundus examination in both eyes. Neurologic examination was normal. There was no history of head or neck trauma in the past weeks. Cocaine drop test for Horner syndrome was negative. Fluorescein and indocyanine green angiography were normal without delayed arterial filling. Cranial MRI with fat-saturated sequences and magnetic resonance angiography (MRA) revealed bilateral acute internal carotid artery (ICA) dissections without fibromuscular dysplasia (figure 1, A–C). Aspirin 100 mg a day was …