• Elias Helou, Ahmad Sweid, Stavropoula Tjoumakaris, Nabeel Herial, Michael R Gooch, Robert H Rosenwasser, and Pascal Jabbour.
• Department of Neurosurgery, University of Saint Joseph, Beirut, Lebanon.
• World Neurosurg. 2019 Aug 1; 128: 336-339.

BackgroundArterial dissections are a common cause of stroke in second decade-fourth decade patients, but may occur at any age. There are no previous reports of an intracranial carotid artery dissection that evolved spontaneously into both complications (i.e., stroke, pseudoaneurysm). To our knowledge, this is the first case of arterial dissection complicated by an occlusion and a pseudoaneurysm occurring at the same site.Case DescriptionThe patient is a 57-year-old woman who was found by a family member with complete right-side weakness and without the ability to communicate. On admission, her National Institutes of Health Stroke Scale score was 18 and her cerebral angiogram showed a left cavernous carotid occlusion. Mechanical thrombectomy failed to open the occlusion; therefore, an enterprise stent was deployed. Four weeks after the left internal carotid artery (ICA) stent placement, the patient presented with a complete ptosis of the left eye with minimally reactive pupil and a third nerve palsy. Computed tomography angiogram showed an 8-mm aneurysm of the left cavernous ICA. A cerebral angiogram was performed and showed a 10- × 7-mm cavernous pseudoaneurysm. The decision was made to treat the aneurysm with Pipeline-assisted coiling. The procedure went well without any complications.ConclusionsIntracranial dissection/occlusion is a frequent cause of brain infarction, especially in mid-adulthood. Clinical signs of subarachnoid hemorrhage, compressive nerve palsies, and epistaxis in a patient who had endovascular treatment for an intracranial arterial dissection occlusion should be considered as signs for pseudoaneurysm formation, and an angiography should be obtained as soon as possible.Copyright © 2019 Elsevier Inc. All rights reserved.

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