Spontaneous internal carotid artery dissection is not an uncommon cause of 
ischaemic stroke in younger patients, but multiple cervical arterial dissections 
at presentation are uncommon. Recurrence of dissection in a previously normal 
artery is common. In this case report we review the history, clinical findings 
and management of a 42-year-old woman who presented with stroke and Horner 
syndrome and was found to have spontaneous bilateral internal carotid artery 
dissection. She was not anticoagulated due to concerns relating to the size of 
her infarct. She was treated with a combination of aspirin and clopidogrel. We 
use dual antiplatelets for the management of cervical dissections as a part of 
the CADISS trial. The patient made good progress with the multidisciplinary team 
and was discharged on day 22 with support from the community stroke team.