Internal carotid artery dissection
He was seen by the chiropractor and underwent cervical manipulation. Next day patient noticed he had difficulty swallowing and his voice sounded hoarse. On exam he had miosis of his left pupil and left sided ptosis.
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MRI T1 with fat suppression: Area of semilunar hyperintensity around Left Internal Carotid artery due to Methemoglobin, consistent with Internal Carotid dissection.
Patient was managed with aspirin therapy and follow up imaging 3 months later.