Spontaneous carotid artery (CA) and vertebral artery (VA) dissections account for ~25% of strokes in young adults.  However, spontaneous multiple vessel dissections are rare. We report the first described case of spontaneous triple vessel dissection in a healthy woman with Turner Syndrome (TS).

A 29-year-old woman, with TS presented with sudden onset transient right-sided weakness, paresthesias, and blurred vision. NIHSS was 1for right-sided hemi-sensory loss. Neuroimaging revealed bilateral VA and left ICA dissection, and left posterior thalamic infarct. No triggers for dissection were identified. An echocardiogram revealed no structural abnormalities. Given triple vessel involvement with flow limitation, she was started on anti-coagulation.

She re-presented to the ED with recurrent right lower extremity numbness, right-sided vision loss, and headache. Exam was significant for a new right visual field deficit. Repeat neuroimaging revealed evolution of prior infarct, with stable left ICA, improving left VA and unchanged right VA dissections. Outpatient rheumatology and hematology workup was unremarkable. She has had no recurrence of symptoms on warfarin.

We report a case of spontaneous triple vessel (bilateral VA and left ICA) dissection in a woman with TS with no identified triggers. While aortic dissection is recognized in TS, the risk of CA and/or VA dissection is not well-known. Vascular complications in TS have been ascribed to an underlying intrinsic vasculopathy, attributed to a relative hypo-estrogenic state. The multiple vessel involvement in our case, especially in the absence of aortic involvement, hints towards an underlying systemic vasculopathy. A literature review identified only 3 prior reports of spontaneous extra- or intracranial dissection of the CA or VA in TS. Our case highlights the significance of recognizing dissection as an etiology of stroke in TS patients. Future studies aimed at targeted interventions are warranted to optimize treatment algorithms in this population.