Presentation
A 50-year-old man with recent onset of headache and neck pain presents with acute left-sided hemiplegia.
Patient Data
Age: 50 years
Gender: Male
From the case:
Carotid arterial dissection with acute cerebral infarction
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- a large right fronto-temporo-parietal cortical and subcortical area of restricted diffusion (high DWI, low ADC signal)
- lesion shows mild T1 hypointensity as well as high T2/FLAIR signal intensity
- lesion is associated with cytotoxic brain edema with mild compression of the right lateral ventricle as well as some effacement of the related cortical sulci
- post contrast administration, the lesion shows luxury perfusion with mild peripheral patchy enhancement
- distal cervical portion of the right ICA shows significant reduction of its caliber and crescentic T1/ T2 hyperintense lesion with restricted diffusion, compatible with subacute blood signal of intramural hematoma
- MR angiography:
- dissection of the distal cervical segment of the right ICA with larger crescentic false lumen eliciting high signal with attenuation of the true lumen (70% arterial luminal diameter reduction)
- attenuated distal segment of the right ICA namely the petrous, cavernous and supraclinoid segments
- mild attenuation of the right MCA is noted
- normal left ICA and the rest of the cerebral arteries as well as the vertebro-basilar arteries with no significant stenosis or occluded segment
- no aneurysmal dilatation of AV malformation
normal MRV examination of the brain
Case Discussion
Right distal cervical ICA dissection with intramural hematoma and resultant right fronto-temporo-parietal acute cerebral infarction.