Cough-Induced Extracranial Internal Carotid Artery Dissection

Background: Coughing due to respiratory tract infections may lead to internal carotid artery (ICA) dissection. Aim: We are presenting a patient with an unusual cough-induced ICA dissection. Case Report: A 42-year-old health care worker presented with bilateral hand numbness which resolved spontaneously. This initial episode was followed 9 days later with intermittent episodes of right hand and leg weakness with speech difficulty. Two days later, he had another episode of speech difficulty. One week prior to the first presentation, he had upper respiratory tract infection with ongoing strong bouts of coughing. Magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) of the brain showed early ischaemic changes at the left frontal and left parietal regions. MR angiography (MRA) showed high signal intensity at the left proximal ICA and poor flow beyond the left carotid bulb. Cerebral angiography revealed left ICA dissection. Conclusion: Proper identification of cough-induced extracranial ICA dissection is important because this is treatable.