Carotid arterial dissection with acute cerebral infarction
50 year old man with recent onset of headache and neck pain presents with acute left sided hemiplegia.
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- A large right fronto-temporo-parietal cortical and subcortical area of restricted diffusion with high DWI and low ADC signal, the lesion shows mild T1 hypointensity as well as high T2/FLAIR signal intensity. The lesion is associated with cytotoxic brain oedema 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.
- The distal cervical portion of the right ICA shows significant reduction of its calibre and crescentic T1/ T2 hyperintense lesion with restricted diffusion compatible with subacute blood signal of intramural haematoma.
MR angiography shows:
- 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.
- Rahme RJ, Aoun SG, McClendon J et-al. Spontaneous cervical and cerebral arterial dissections: diagnosis and management. Neuroimaging Clin. N. Am. 2013;23 (4): 661-71. doi:10.1016/j.nic.2013.03.013 - Pubmed citation
- Renard D, Delorme M, Castelnovo G. Hyperintense intramural hematoma on time-of-flight sequences in carotid dissection. Eur. Neurol. 2013;70 (3-4): 141. doi:10.1159/000351351 - Pubmed citation