PMC8440883_01
Brain and vascular imaging at 4 different times. Brain MRI at 4 times showed multiple lesions in the left ICA territory. Vascular imaging showed no evidence of vascular stenosis or occlusion.
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F1
A repeat MRI at our institution showed multiple lesions in the left MCA territory, indicating a convalescent ischemic stroke (Figure 1).
Carotid doppler ultrasound spectrum (DUS) (A,B) and TCCD (C,D). (A,B) There was a heterogeneous echo outside the left carotid bifurcation, and the lumen at the distal end of the left CCA was compressed by the hyoid bone in the rotated neck position (red arrow: the hyoid bone; white arrow: compressed arterial lumen; yellow asterisk: increased IMT). (C) The flow velocity of the left MCA was normal in the neutral position. (D) The flow velocity of the left MCA decreased significantly with neck rotation.
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F2
When the patient was in the right lateral decubitus position with neck rotating to the left, the carotid duplex scan demonstrated a compressed and narrow lumen at the distal end of the left common carotid artery (CCA), which was related to the hyoid bone, and the transcranial color-coded Doppler (TCCD) showed a significantly decreased flow velocity of the left MCA (Figure 2).
CTA demonstrated a close contact between the enlarged left greater horn of the hyoid bone and the carotid bifurcation. -, The serial CT slices from distal CCA to proximal ICA. (red arrow: CCA, blue arrow: ICA, white arrow: ECA, yellow arrow: hyoid bone).
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F3
He subsequently underwent a computed tomography angiography (CTA) of the neck and head, which revealed an enlarged left hyoid bone on close contact with carotid bifurcation, without evidence of artery stenosis (Figure 3).