PMC5580704_01
Ultrasonography investigation with diagnosis of left ICA dissection (case 1).. Notes: (A) Right CCA; (B) left CCA; (C) right ICA; (D) left ICA; resistive index values are underlined - increased in the left CCA (0.83) compared with the right CCA (0.69) and in the left ICA (1.00) compared with the right ICA (0.53); absence of blood flow in the left ICA (arrow).. Abbreviations: CCA, common carotid artery; ICA, internal carotid artery.
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Exploration of the cervical and intracranial arteries by ultrasound did not show any atherosclerotic lesions but revealed high resistive index values in the left CCA and ICA with decreased cerebral blood flow in the supply arteries (Figure 1).
Cervical CT angiography and brain MRI with diagnosis of left ICA dissection and cerebral infarction (case 1).. Notes: (A) Cervical CT angiography showing long tapered stenosis (arrow) of the left ICA; (B) axial cervical CT angiography showing stenosis with narrowing of left ICA lumen and increased arterial diameter by hematoma (arrow); (C) axial fat-suppressed T1-weighted MRI showing hematoma in the left ICA wall (arrow); (D) diffusion-weighted MRI showing recent left infarction (arrow).. Abbreviations: CT, computed tomography; ICA, internal carotid artery; MRI, magnetic resonance imaging.
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Brain CT angiography confirmed an extremely tight stenosis remote from the left ICA bulb and extended over 2 cm (Figure 2A), with a 30% increase in artery diameter compared with the right ICA (Figure 2B). Brain magnetic resonance imaging (MRI) showed high-intensity signal on cervical axial fat-suppressed T1-weighted sequence proving the presence of hematoma at the level of stenosis (Figure 2C) and recent left anterior watershed infarction on diffusion-weighted sequence (Figure 2D).
PMC5580704_02
Left Horner syndrome.. Note: Miosis (white arrow) and ptosis (black arrow).
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Neurological examination showed a left Horner syndrome with no neurological deficit (Figure 3).
Cervical MR angiography with diagnosis of left ICA dissection (case 2).. Note: (A, B) Cervical MR angiography showing aneurysmal dilation topped with stenosis (pearl-and-string sign) (arrows).. Abbreviations: ICA, internal carotid artery; MR, magnetic resonance.
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A brain MRI with angiography of the cerebral arteries was performed which revealed an aneurysmal dilation topped with a stenosis in the subpetrous portion of the left ICA (Figure 4A and B) without any cerebral ischemic consequences on diffusion-weighted sequence or former infarctions on FLAIR sequence.