Acute three-vessel cervical arterial occlusion due to spontaneous quadruple cervical artery dissection

Cervical artery dissection (CAD) is one of the most frequent causes (14.5%) of stroke in young adults. Cases with involvement of more than two arteries are rare. Arnold et al described 11 cases (1.5%) with triple CAD of a reported 740 patients and just a single (0.1%) quadruple case in the same population. Simultaneous dissection of the four principal vessels is extremely rare. According to Papagiannaki et al, the incidence of simultaneous three or four CADs is 1-3/million in the general population. To the best of our knowledge, there are only three published cases of spontaneous quadruple CAD.