The management of the bilateral internal carotid dissection clinical case presentation

Introduction:We present the case of a 36-year-old patient who was treated in the National Institute of Neurology and Cerebrovascular Diseases in Bucharest – in the neurology and the imagistic departments - for bilateral carotid dissection. Goals: The main goal of this article was to discover the cause that lead to the symptoms of the patient using MRI and angio-MRI.In the process,we tried to dilate the stenosis (due to dissection) on 2 internal carotid arteries by using stents in order to keep the true lumen open. Methods:In order to make a diagnosis we used the Magnetic resonance imaging machine (MRI) (1,5 T from GE), the multislice Computer Tomography (CT) scan (16 detectors from Siemens) and the digital substraction angiography (Siemens Axiom Artis). In addition, we used the same angiography machine for the endovascular procedure. The stents that we used were Wallstents from Boston Scientific Company. Results: The patient left the hospital having a NIHSS=10, with dysarthria and left hemiplegia that were 80% recovered after 2 months. Discussion: The particularity of this case study is the spontaneous bilateral internal carotid dissection. The second dissection might have resulted in being also iatrogenic, due to several attempts of stenting the first one. Conclusions: The successful treatment of this patient was the result of the collaboration between the neurology and neuroradiology departments.The first therapeutic option in carotid dissection has to be stenting, under certain conditions.