giologic ICA alterations, an iatrogenic cause seemed ob­vious. Although rarely reported, the question was raised whether our patient had a particular predisposition to develop adissection during selective catheter angiography because of the already present intracranial spontaneous dissection. An inherited or acquired abnormality of the intimalormedialvessellayersoroftheelasticconnective tissue, as for instance in Marfan syndrome, Ehlers–Danlos syndrome, and pseudoxanthoma elasticum, could result in increased spontaneous vessel wall vulnerability (Schie­vink 2001) and possibly also an increased vulnerability, for example, to mechanical manipulations. Brandt and coworkers (1988) reported ultrastructural collagen alter­ations and alterations of the extracellular matrix in skin specimens of patients with extracranial dissections, which then may lead to generalized arteriopathy, associated in­tracranial pseudoaneurysms, an aortic dilatation, and/or hyper-distensibility of arterial walls (Guillon et al. 2000, Hausser et al. 2004). However, none of these conditions were found in our patient, and she had no suggestive family history. Therefore, the assumption of a particular predisposition to vessel wall injuries in our patient re­mains speculative.