Spontaneous Dissections of the Carotid Arteries in a Patient with Recent Coronary Artery Dissection

pravastatin 20 mg daily. Post-myocardialinfarction echocardiography had demonstrated anteroseptoapical hypokinesia with low left ventricular ejection fraction (50%). On admission, right hemiparesis and aphasia had cleared. The patient had no history of recent infection (no fever, no flu, no respiratory tract symptoms) and reported no prior transient neurological deficit, headache or cervical pain. No Horner’s syndrome was observed. The patient had no skin, joint, eye or skeletal abnormalities suggesting a hereditary connective tissue disorder. No family history of arterial dissection or valvular heart disease was noted. Multimodal MRI performed on June 27 showed no recent ischemic lesion on diffusion-weighted imaging. T 2 -weighted sequences showed bilateral middle cerebral artery/anterior cerebral artery borderzone hyperintensities. Magnetic resonance angiography showed occlusion of the right ICA beginning 1 cm after the bifurcation and narrow stenosis of the left ICA in the subpetrous segment consistent with the diagnosis of bilateral spontaneous ICA dissection ( fig. 2 ). Collateral supply was efficient through the right posterior communicating artery. No intramural hematoma was observed. No angiographic changes of fibromuscular dysplasia were found. Neck Dear Sir, Multiple dissections of the carotid and coronary arteries are exceptional [1] . We report the case of a young woman without known hereditary connective tissue disorder who presented with spontaneous dissection of the left anterior descending coronary artery, followed by spontaneous dissection of both internal carotid arteries (ICA) 3 weeks later. We discuss the pathogenesis of these multiple dissections.