A 45-year-old woman presented with persistent global headaches lasting three days, accompanied by left arm and face weakness. One year earlier, she experienced painful swelling in her right mid-neck, which resolved after one week of ibuprofen. A CT angiogram then revealed transmural concentric thickening of the common carotid artery and the contiguous internal carotid artery (ICA), leading to a diagnosis of TIPIC syndrome based on her clinical and radiologic features.

During her recent presentation, a repeat CTA showed subtotal occlusion of the right proximal ICA. MR angiography revealed concentric gadolinium uptake throughout the carotid wall, while a cerebral MRI confirmed scattered ischemic infarctions in the right carotid distribution. Ultrasound findings indicated an intraluminal filling defect with adjacent mural thickening with equivalent tissue densities, suggesting progression from the previous year. This supported a diagnosis of recurrent carotidynia, implying that the wall thickening and luminal stenosis resulted from progressive concentric homogeneous mural inflammation rather than atherosclerosis.

Serological tests for infectious and non-infectious causes of systemic arteritis and hypercoagulable conditions returned normal results. The patient was treated with a five-week course of steroids and standard secondary stroke prevention measures, leading to symptomatic improvement four months post-discharge. A follow-up carotid ultrasound five months later showed no residual focal stenosis.