Abstract
Background
Internal carotid artery (ICA) dissection is a relatively rare cause of acute ischemic stroke. Stretching and compression of the ICA owing to sudden acceleration, deceleration, and rotational forces are risk factors for ICA dissection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to trigger an inflammatory response exacerbating endothelial dysfunction leading to arterial dissection. Although levodopa-induced cervical dyskinesia in Parkinson’s disease often manifests as choreiform movement, dissection has not been reported in such patients.
Case Presentation:
A 51-year-old man with Parkinson’s disease (PD) presented with gradually worsening neck pain and transient aphasia one week after mild coronavirus disease 2019 (COVID-19) infection. The patient presented with levodopa-induced cervical dyskinesia. Magnetic resonance imaging revealed acute ischemic stroke in the left parietal lobe and an intramural hematoma with an area of stenosis in the left ICA. The patient was diagnosed with a left ICA artery dissection.
Conclusions
The quick cervical movement under COVID-19-related vessel wall vulnerability may cause ICA dissection. Although patients with PD often have neck pain, ICA dissection should be included as a differential diagnosis if the patient has COVID-19.