Spontaneous dissection of the extracranial internal carotid artery (ICA) is a major cause of stroke with severe residual handicap in young adults.¹ Recently, stent supported angioplasty has been used to treat intimal dissection in case of neurological symptoms while on anticoagulation or as an alternative to the traditionally accepted use of anticoagulation.^2,3 We report a case of internal carotid artery dissection causing hemiplegia successfully treated with emergent endovascular stenting followed by intra-arterial thrombolysis.

Case report

A 44 year old right handed man was admitted to the emergency room after an acute episode of left side weakness, which resolved within three hours. The patient had been well until the onset of symptoms. There was no history of trauma, strenuous exercise, hypertension, or other medical problems. In the week prior to admission, he reported intermittent headaches and right sided neck pain after four days of diving. A cranial computed tomography (CT) scan was normal. Diffusion weighted imaging (DWI) of the brain performed six hours after the onset of symptoms while the patient was asymptomatic showed no evidence of infarction. T2-weighted magnetic resonance images and fat suppressed images showed a semilunar hypersignal of a mural haematoma in the infrapetrous segment of the right ICA suggestive of a dissection. Low molecular weight heparin treatment (enoxaparin sodium 1 mg/kg subcutaneously every 12 hours) was started to obtain true anticoagulation.

Three hours later, the patient had sudden left sided hemiplegia, …