Atypical Presentation Versus an Incidental Finding: A Case of Carotid Artery Stenosis.

Carotid artery stenosis (CAS), a vascular condition that typically presents with symptoms related to the anterior circulation, rarely manifests with posterior circulation symptoms such as vertigo. We present a rare case involving a man in his late 60s who reported vertigo, a chronic unilateral headache, and altered sensation and pain in his left hand, without any signs of anterior circulation involvement. Imaging revealed severe bilateral CAS with no evidence of posterior infarct on MRI. Initial medical management was followed by referral to a vascular clinic and multidisciplinary team (MDT) review. The patient subsequently underwent a successful right carotid endarterectomy and experienced complete resolution of symptoms on postoperative follow-up. This case highlights the importance of recognizing atypical presentations of CAS. Posterior symptoms may, in some cases, be associated with CAS and therefore should not be disregarded during diagnostic evaluation. Multimodal imaging and MDT-guided decision-making were pivotal in the effective management of this complex presentation.