Clinical Practice and Cases in Emergency Medicine

ABSTRACT

Introduction
We present a unique case report of a patient who presented to the emergency department
with stroke-like symptoms found to have a spontaneous left sided internal carotid artery
dissection. 
Case Report
The patient was treated successfully with thrombectomy, and subsequently developed
contralateral symptoms caused by a right sided internal carotid artery dissection. This was
managed with a second contralateral thrombectomy.  The patient’s course was complicated by
persistent and mild hypotension, postulated to be secondary to bilateral carotid baroreceptor
trauma from the dissections. 
Conclusion
This case highlights the importance of close neurological monitoring for patients,
preferably in a neurologic critical care setting, during and after invasive treatments such as
systemic thrombolytic administration or mechanical thrombectomy, as identifying the patient’s
subsequent development of contralateral symptoms in a timely fashion was key to his positive outcome.  An additional factor which had a positive impact on this outcome was the use of the RAPID Artificial Intelligence software which assists in determining whether thrombectomy may
be indicated prior to receiving a formal radiologist read on CT angiography/perfusion studies. 
AI technologies such as this have a great potential to augment and expedite patient care.