BMJ Case Reports 2017; doi:10.1136/bcr-2017-219927
  • Reminder of important clinical lesson

Headache, TIA and subarachnoid haemorrhage: dissecting an unusual cause for stroke-like symptoms

  1. Alejandro A Rabinstein1
  1. 1Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Elliot T Dawson, dawson.elliot{at}
  • Accepted 17 June 2017
  • Published 13 July 2017


We present a case of supraclinoid internal carotid artery dissection. Eleven months prior, the patient developed isolated periorbital pain and was diagnosed with giant-cell arteritis with iritis. The patient experienced recurrent spells concerning for transient ischaemic attacks and was transferred to our institution for endovascular intervention after head CT revealed an embolic infarct with a ‘dense middle cerebral artery sign.’ Digital subtraction angiography was negative for occlusion, instead demonstrating luminal stenosis and poststenotic dilatation. He subsequently experienced acute neurological decline secondary to massive subarachnoid haemorrhage. Non-invasive vascular imaging revealed an intimal flap and a pseudoaneurysm at the site of luminal stenosis, confirming our suspicion for intracranial carotid artery dissection. Given the moribund clinical state, the family opted to withdraw care, and he quickly expired.


  • Contributors ETD and DAB have substantially contributed to the planning, authorship and review of this manuscript. AAR has substantially contributed to the authorship and review of this manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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