Craniocervical arterial dissection has been identified as a potential complication of cervical massage and may lead to ischemic stroke. The occurrence of vascular dissection substantially increases the likelihood of thrombosis, cerebral ischemia, paralysis, and mortality. This risk is further elevated in individuals with extensive carotid artery calcification and elongated styloid processes. Reports involving older adults with multiple predisposing factors who experience such adverse events remain uncommon in the literature.An older adult presented with aphasia and right-sided limb weakness immediately following a cervical massage. Computed tomography angiography (CTA) of the head and neck demonstrated carotid artery dissection, pronounced arterial calcification, and an elongated styloid process. The ischemic stroke was attributed to thromboembolism, likely precipitated by carotid intimal injury, thrombosis, and plaque rupture, with possible contribution from cerebral hypoperfusion. Intravenous thrombolysis was administered, followed by the initiation of dual antiplatelet therapy after 24 hours. This regimen was maintained for 3 months. No recurrent ischemic events were observed during the follow-up period.Heightened awareness of the potential cerebrovascular risks associated with cervical massage is warranted, particularly in populations with underlying vascular abnormalities. Increased clinical vigilance may contribute to the prevention of serious cerebrovascular complications.Copyright © 2025 by Mutaz B. Habal, MD.