There are many associated conditions and risk factors for cervical artery dissection. Published cases of bilateral vertebral artery dissections (VADs) have occurred in the setting of chiropractic manipulation, rollercoasters, massage, motor vehicle collision, sports, and exercise. Bilateral VADs secondary to severe coughing have not been described in the literature.

A 43-year-old active duty female with no significant medical history presented to the emergency department with sudden onset of blurry vision and vertigo, shortly after a coughing fit. She described a fluctuating “starburst” pattern in her left visual field. She had a recent upper respiratory infection with persistent coughing and associated neck pain. During a coughing fit one week earlier, she had also strained her back. CT angiography demonstrated bilateral VADs of right V1-V3 and left V2-V3 segments, with associated near occlusion of the right V3 segment and occlusion of the left V3 segment. While in the emergency department, she continued to have intermittent visual scotoma, so a heparin fusion was initiated with subsequent resolution of symptoms. MRI brain was negative for acute or chronic infarction. She was transitioned from heparin to oral rivaroxaban and discharged home. Chromosome sequencing analysis was negative for mutations associated with connective tissue disorders. Repeat CTA 6 months later demonstrated complete resolution of the dissections, and she remained asymptomatic at follow-up.

There are many conditions and precipitating events which have been associated with cervical artery dissection. Based on our literature review, bilateral VADs are uncommon and have never been described in the setting of severe coughing. This case highlights a unique cause of bilateral VADs and demonstrates that full healing is still achievable with medical therapy, despite the severity of the dissections.