Dissection of the internal carotid artery (ICA) accounts for 5% of ischemic strokes in young adults.
Initial and follow-up evaluation of the extra-cranial and intracranial vascular systems can be performed with
carotid duplex (CD) and transcranial color – coded duplex ultrasound (TCCD). We report a case of spontaneous recanalization of traumatic ICA dissection. A 47-year-old male presented with intermittent episodes of headache, blurry vision, anisocoria and loss of taste sensation following whiplash injury during body surfing. Magnetic Resonance Angiogram (MRA) of the neck revealed absent flow in the cavernous ICA and a clot at skull base. Carotid Duplex showed reverberating color doppler and spectrum signal. TCCD showed ICA occlusion and smaller caliber intracranial ICA. After 1 month being on anticoagulation therapy, patient reported for follow up examination after his headache subsided. CD and TCCD were normal and ICA showed normal color and spectrum signals. Computer Tomography Angiogram confirmed ultrasound findings. Dramatic improvement of ICA patency and symptoms resolution were co-found. Occlusion of the internal carotid artery due to dissection can recanalize spontaneously. Extra-cranial carotid duplex and TCD examination are useful for monitoring patient progress. These inexpensive and non-invasive modalities are an alternative to invasive angiogram and provide more hemodynamic information than “static” MRA.