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Images from 1.5-T Avanto (Siemens, Munich, Germany) magnetic resonance imaging (MRI). (A) Axial T2-weighted MRI of the neck. Flow voids in both common carotid arteries (arrows), indicating arteries are perfused normally. Thin flow voids in both vertebral arteries (VA), indicating reduction of arterial lumen (open arrows). (B) Axial T2-weighted MRI of the base of the skull. Flow voids in both VAs (open arrows) but only partial flow voids in both internal carotid arteries (arrows), indicating reduced perfusion.
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A secondary finding was an elongated dissection of both vertebral arteries in the V2 segment (Fig. 1). However, imaging did show stenosis due to intimal flaps of both carotid arteries between the carotid bifurcation and the base of the skull without signs of thrombosis (Fig. 1).
Computed tomography angiography on 16-Slice Sensation (Siemens, Munich, Germany). (A) Normally perfused common carotid arteries (white arrows) but filiform-perfused vertebral arteries (VA) (black arrows) at the level of the larynx. (B) Filiform-perfused internal carotid arteries (ICA) and normally perfused VAs at the base of the skull. (C) Regular perfusion of basilar artery and both ICAs at level of carotid canal.
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The diagnosis of quadruple cervical arterial injury was confirmed by computed tomography angiography (CTA; Fig. 2).
Images from 3-T TrioTim (Siemens, Munich, Germany). (A) Both common carotid arteries and vertebral arteries (VA) open with residual reduction of lumen of right VA. (B) At the base of the skull, all four arteries are perfused; however, both internal carotid arteries still show reduced lumen.
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MRI after 3 months showed that all arterial lesions had regressed in size (Fig. 3).