Carotid dissection is a common cause of stroke in the young patient and can present with various clinical syndromes or symptoms. These may include stroke or transient ischaemic attack,¹ ipsilateral ptosis, isolated or multiple cranial nerve palsies,² carotidynia, hemicrania,³ scintillating scotomata, pulsatile tinnitus, or subjective bruit.⁴ I recently cared for a man who experienced an audible "creaking" sound heard even by his wife in the hours before a right middle carotid artery (MCA) infarct secondary to a carotid dissection. I think that this sound represented the actual dissection.

A forty three year old, right handed lawyer with a presumed viral pharyngitis and severe cough for two weeks duration returned from work at 6 00 pm and began hearing periodic, high frequency, "creaking" sounds in his right ear. These sounds occurred every 1-2 hours lasting a few seconds each time. These sounds were not pulsatile or rhythmic. He had not experienced these sounds . . . [Full text of this article]