PMC9631311_01
Diagnostic work-up and follow-up. (a) Initial computed tomography of the brain was unremarkable. (b) Computed tomography of the brain 24 h after symptom onset revealed an incomplete ischemic lesion within the territory of the right lenticulo-striatal arteries. Computed tomography angiography (c) and conventional cerebral angiography (d) revealed a filiform stenosis of the right internal carotid artery about 1.5 cm from the carotid bifurcation. (e-g) transversal computed tomography scans showed an intramural haematoma of the right internal carotid artery. (h) Transversal T1-weighted magnetic resonance imaging with fat suppression confirmed mural haematoma of the right internal carotid artery. (i) Conventional angiography after intra-arterial mechanical thrombectomy and stent implantation illustrated no residual stenosis of the right internal carotid artery. (j) Fluid attenuated inversion recovery magnetic resonance imaging 10 weeks from symptom onset revealed the ischemic lesion within the territory of the right lenticulo-striatal arteries, but no additional infarction.
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F1
The computed tomography of the brain 3 h after symptom onset was unremarkable (Figure 1a). Additional computed tomography-angiography of the cerebral vessels revealed an incomplete, filiform occlusion of the right internal carotid artery ~1.5 cm distal to the carotid bifurcation (Figure 1c) and thrombus in the middle cerebral artery. These findings were confirmed by conventional angiography (Figure 1d). Transverse computed tomography scans showed wall swelling of the right internal carotid artery due to extensive intramural hematoma (Figures 1e-g). The transverse T1-weighted magnetic resonance imaging with fat suppression 10 weeks after symptom onset confirmed the mural hematoma of the right internal carotid artery (Figure 1h). Intravenous thrombolysis, followed by stent implantation within the right internal carotid artery, followed by mechanical thrombectomy was performed (Figure 1i). One day after the onset of symptoms, the computed tomography of the brain showed an incomplete ischemic lesion in the right lenticulostriatal arteries (Figure 1b), which was confirmed by magnetic resonance imaging with attenuated inversion recovery 10 weeks after the onset of symptoms (Figure 1j).