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OBJECTIVES: This is a report of a symptomatic cervical internal carotid artery fenestration first diagnosed by duplex ultrasound. Case reports of similar radiologic findings in symptomatic patients are scattered throughout the international literature amongst multiple specialties: neurosurgery, neuroradiology, neurology, ENT, radiology, vascular surgery. This heterogeneity is likely secondary to the diverse ways these patients can present.
METHODS: The image presented here was obtained by our diagnostic vascular laboratory as part of an outpatient exam. We researched this individual case and performed a comprehensive review of the literature. A MRA of neck and head were also obtained, confirming the duplex findings.
RESULTS: This patient is a 32 year old female six months post partum; her pregnancy was complicated by preeclampsia and preterm labor. She began having tinnitus after her delivery. While there are reports that cerebral blood vessels can have embryological variations and defects, it is likely that fenestrations such as this patient’s are actually chronic dissections.
CONCLUSIONS: Vascular surgeons and those that read vascular ultrasound studies should be aware of this unusual presentation of symptomatic carotid fenestration and cognizant that it may represent chronic dissection.