A Strategy for When Two Rare Entities Strike at Once: Carotid Artery Dissection With Carotid Sinus Hypersensitivity and Syndrome.

Carotid artery dissection involving the sinus region can lead to both neurologic and cardiovascular complications. We present the case of a previously healthy, middle-aged man with no known risk factors who arrived at the Emergency Department with an acute middle cerebral artery infarct. During hospitalisation, he developed recurrent syncope, bradycardia, and hypotension - unresponsive to carotid sinus massage. Imaging confirmed a carotid artery dissection extending into the carotid sinus. While stroke management was initiated, ongoing cardiovascular instability required the placement of a permanent pacemaker. This case emphasises the need to consider carotid dissection in stroke patients without typical comorbidities, and to recognise carotid sinus involvement as a cause of severe autonomic dysfunction.