Carotid arterial dissections may result from spontaneous or traumatic causes. Postcoital arterial dissections have been reported in both the vertebral and coronary arteries. We report a rare case of spontaneous dissection from the common carotid artery to the internal and external carotid arteries after sexual intercourse, leading to fulminant middle cerebral artery (MCA) territory infarct. Although we restored the flow in the proximal carotid artery with stenting, brain swelling with hemorrhagic transformation was still noted in the region of the right MCA.