We describe a patient with a stroke in the territory of the right middle cerebral artery in whom the initial manifestation was unilateral pulsatile headache and positive visual symptoms. Doppler echography and cerebral angiography demonstrated dissection of the cervical internal carotid artery. Extracranial internal carotid artery dissection may present in a similar way to the migraine-stroke syndrome. Appropriate imaging investigations are essential in order not to overlook the diagnosis.
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