PMC5829091_01
PMC5829091_02
Arterial dissections noted in both vertebral arteries on MRI angiography following the patient's second week on lenvatinib (14 mg) treatment.
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F1
Concerned with these symptoms, both a fat-saturated T1-weighted MRI of the brain and an MRI angiogram (MRA) of the cervical and cranial vessels were performed, revealing dissecting aneurysms in both the vertebral (Figures 1-3) and left-internal carotid (Figure 4) arteries in addition to T1 crescent-shaped hyperintense methemoglobin in the dissected walls, indicating mural hematomas (Figures 5 and 6).
Additional MRI angiography imaging revealing bilateral focal loss of flow-related enhancement in the distal cervical vertebral arteries with distal antegrade flow compatible with bilateral vertebral dissections with severe stenosis and antegrade collaterals.
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F2
Concerned with these symptoms, both a fat-saturated T1-weighted MRI of the brain and an MRI angiogram (MRA) of the cervical and cranial vessels were performed, revealing dissecting aneurysms in both the vertebral (Figures 1-3) and left-internal carotid (Figure 4) arteries in addition to T1 crescent-shaped hyperintense methemoglobin in the dissected walls, indicating mural hematomas (Figures 5 and 6).
(A-D) Successive CT with IV-contrast images (0.75 mm) depicting a segment of non-opacification within the right vertebral artery and a normal vertebral canal at level C3, which suggests that the stenosis is not related to vascular hypoplasia within that area.
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F3
Concerned with these symptoms, both a fat-saturated T1-weighted MRI of the brain and an MRI angiogram (MRA) of the cervical and cranial vessels were performed, revealing dissecting aneurysms in both the vertebral (Figures 1-3) and left-internal carotid (Figure 4) arteries in addition to T1 crescent-shaped hyperintense methemoglobin in the dissected walls, indicating mural hematomas (Figures 5 and 6).
Visualization of an additional dissection noted within the left-internal carotid artery on MRI angiography, an examination which was prompted due to the onset of acute headaches.
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F4
Concerned with these symptoms, both a fat-saturated T1-weighted MRI of the brain and an MRI angiogram (MRA) of the cervical and cranial vessels were performed, revealing dissecting aneurysms in both the vertebral (Figures 1-3) and left-internal carotid (Figure 4) arteries in addition to T1 crescent-shaped hyperintense methemoglobin in the dissected walls, indicating mural hematomas (Figures 5 and 6).
A hyper-intense, crescent-shaped signal noting the presence of an acute thrombus within the cranial arteries on MRI angiography.
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F5
Concerned with these symptoms, both a fat-saturated T1-weighted MRI of the brain and an MRI angiogram (MRA) of the cervical and cranial vessels were performed, revealing dissecting aneurysms in both the vertebral (Figures 1-3) and left-internal carotid (Figure 4) arteries in addition to T1 crescent-shaped hyperintense methemoglobin in the dissected walls, indicating mural hematomas (Figures 5 and 6).
Additional MRI imaging indicating mural hematomas within the right (A,B) and left (B) vertebral arteries, findings that would resolve following anticoagulant therapy and the cessation of lenvatinib.
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F6
Concerned with these symptoms, both a fat-saturated T1-weighted MRI of the brain and an MRI angiogram (MRA) of the cervical and cranial vessels were performed, revealing dissecting aneurysms in both the vertebral (Figures 1-3) and left-internal carotid (Figure 4) arteries in addition to T1 crescent-shaped hyperintense methemoglobin in the dissected walls, indicating mural hematomas (Figures 5 and 6).
Follow-up MRI angiogram showing interval improvement of the left vertebral (A) and internal carotid arteries (B):without evidence of new dissection or aneurysm:and persistent right cervical vertebral artery contour irregularity (A).
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F7
Repeat MRI and MRA scans performed in July of 2016 displayed improvement of both the left ICA and vertebral artery, though the right vertebral artery remained diffusely narrower than the prior scan (Figure 7).