Reversible cerebral vasoconstriction syndrome (RCVS) is a distinct clinical syndrome characterized by thunderclap headache and reversible cerebral vasoconstriction. An association between RCVS and arterial dissection has emerged in recent years, where dissection typically involves the cervical vertebral arteries. In this vignette, we describe isolated reversible vasoconstriction, involving the extracranial arteries and intracranial dissection—a combination hitherto never reported.