PMC8842151_01
(a-d) CT angiography and neurovascular ultrasound at admission. Red arrows:
intraarterial mass inside the left proximal ICA, suspicious for hematoma of the vessel
wall; blue arrows: residual lumen of the left ICA. (a) CT angiography with short segment
stenosis and residual eccentric lumen in the left carotid bulb. (b) Flow signal in close
proximity to the wall hematoma. (c) Axial cross-section (B-mode). (d) Sagittal
longitudinal section (B-mode). Dotted yellow line: measurement of 6.8 mm.. CT, computed tomography; ICA, internal carotid artery.
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Large vessel occlusion was absent in CT-angiography, but irregularities in the left carotid bulb with suspected short-segment stenosis due to atypical dissection were found (Figure 1a). Ultrasound examination confirmed a short vessel wall hematoma in the proximal internal carotid artery (ICA) (Figure 1b-d) without signs of arteriosclerosis.
(a-e) Confirmation of left ICA dissection in MRI and follow-up images after 12 weeks.
MRI with T1-weighted, fat-saturated images (a-b) and time-of-flight angiography (c-d)
showing suspicious ICA dissection in week 0 (a, c) and improvement at follow up in week
12 (b, d). (e) Diffusion-weighted imaging at week 0 shows a diffusion restricted pattern
in the territory of the left medial cerebral artery matching haemodynamic infarction.
(f) Follow-up neurovascular ultrasound at 12 weeks shows receding vessel wall hematoma
(dotted green line: 4.5 mm).. ICA, internal carotid artery; MRI, magnetic resonance imaging.
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The diagnosis of ICA dissection was supported by magnetic resonance imaging (MRI) of the brain and neck with a focal proximal ICA dissection and cerebral infarctions in the left MCA territory (Figure 2). Follow-up examination in our outpatient clinic including ultrasound and MRI 3 months later confirmed full neurological recovery, albeit with incomplete remission of ICA vessel wall injury (Figure 2d, f).