Dissection of the internal carotid artery with subarachnoid haemorrhage

Introduction. Dissection of the intracranial arteries is uncommon, forming less than 10% of all cranio-cervical dissections. Apart from the classical clinical findings of extracranial dissections, intracranial dissection may cause subarachnoid haemorrhage (SAH), mainly dissections involving the posterior circulation. Clinical case. We describe the case of a 49 year old man, a smoker, who had a sudden onset of headache followed by loss of consciousness. On CT there was SAH and multiple cerebral infarcts. Arteriography showed findings compatible with dissection of the extracranial and intracranial carotid arteries. Discussion. We discuss the epidemiology and mechanisms of SAH associated with intracranial dissections. Intracranial dissection should be considered in the differential diagnosis of SAH and of ischaemic syndromes [REV NEUROL 1997; 25: 882-883].