spontaneous recanalization after carotid artery dissection precipitated by severe cough in a patient with recent covid-19

Internal carotid artery dissection (icad) is an uncommon cause of stroke that can be triggered by violent coughing during respiratory infections. a 47-year-old man was reported to have developed left-sided headaches, retro-orbital pain, photophobia, pulsatile tinnitus, and partial horner syndrome one week after symptomatic sars-cov-2 infection with intense coughing. non-contrast head ct was normal, but ct angiography demonstrated severe tapering of the left internal carotid artery across the cervical and petrous segments, with preserved perfusion of the anterior circulation via the circle of willis and external carotid collaterals. the patient received 24 hours of intravenous unfractionated heparin, followed by two weeks of dual antiplatelet therapy (aspirin and clopidogrel), and was discharged neurologically intact. in six months, mr angiography showed complete recanalization of the left internal carotid artery; residual symptoms were limited to mild left upper eyelid ptosis. this case highlights cough-associated icad in the post-covid setting and underscores the importance of early vascular imaging in patients with recent respiratory infections who present with abrupt ipsilateral head/neck pain, retro-orbital symptoms, tinnitus, or horner syndrome. prompt recognition and short-course antithrombotic therapy may prevent ischemic complications and can coincide with spontaneous arterial healing.