A 41-year-old man with hypertension developed pulsatile tinnitus in his left ear, a left-sided retro-orbital headache, and blurred vision 3 days after cracking his neck to relieve stress from aviation work. His wife noticed a swollen blood vessel on the left side of his head and took a photograph on her cell phone (Figure 1A) of his acutely engorged and pulsatile left superficial temporal artery (STA). She brought him to the hospital, where his blood pressure was 112/63 mm Hg and magnetic resonance angiography (MRA) revealed an acute left internal carotid artery (ICA) dissection (Figure 2A). On fat-suppression sequences of the MRA, a semilunar hyperintense signal indicated an ICA intramural hematoma. Diffusion-weighted magnetic resonance imaging (MRI) demonstrated multiple small acute infarcts within the anterior circulation territory of the ipsilateral hemisphere (Figure 2B). The appearance and distribution of the strokes indicated embolization from the ICA dissection. He was given therapeutic anticoagulation with intravenous heparin. Hours later, his STA was no longer bulging; it had soon normalized in size and pulsatility and appeared unremarkable on a follow-up photograph (Figure 1B) at that time.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Karl A. Kasischke, MD, Pioneer Neurohealth, AdventHealth Tampa, 13067 Telecom Pkwy N, Tampa, FL 33637 (firstname.lastname@example.org).
Published Online: February 14, 2022. doi:10.1001/jamaneurol.2021.5382
Conflict of Interest Disclosures: Dr Rose reported personal fees from Boehringer Ingelheim, Boston Scientific, Medtronic, CSL Behring, and Chiesi and grants from Bristol Myers Squibb/Pfizer outside the submitted work. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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