Internal carotid artery dissection after tonsillectomy in an adult woman.

Glasgow Coma Scale score was E3 V1 M6, the blood pressure 130/70 mm Hg, the pulse 80/min, and she was apyretic. The NIH Stroke Scale score was 25. Throat examination revealed a mild inflammation with swelling of the peritonsillar area. Blood examinations were normal. Brain MRI with diffusion-weighted images demonstrated a large cerebral infarction in the left middle cerebral artery territory, MR angiography showed an irregular stenosis of the left ICA extending from the bulb to the base of the skull. The MR axial scans looking for mural hematoma were noninterpretable due to the clouding of consciousness and agitation, but CT angiography showed widening of the external diameter of the ICA with a crescentic hypodensity around the enhanced narrowed artery ( fig. 1 ) consistent with a mural hematoma. Ultrastructural examination of the skin did not show abnormalities of the elastic tissue, and Ehlers-Danlos syndrome, Marfan syndrome, polycystic renal syndrome, 1-antitrypsin deficiency and fibromuscular dysplasia were excluded. The MR angiography performed 3 months after the onset of symptoms showed recanalization of the left ICA with a slight persistent narrowing of the artery ( fig. 2).