Left internal carotid artery dissection

Case contributed by Dr Kelvin Feng

Presentation

Left-sided ptosis and miosis. Persistent retro-orbital headache. Mildly reduced visual acuity.

Patient Data

Age: 50 years
Gender: Female

Degradation of images by movement/swallowing artifact. Interpretation of findings within this limitation.

Gradual reduction in caliber of the left internal carotid artery from the level of the carotid bifurcation to the carotid canal (C2 segment) with surrounding mural thrombus in keeping with dissection. No large vessel intracranial thrombus. No haemodynamically significant stenosis or evidence of dissection of the vertebrobasilar system.

MRI

MRA Brain + Neck Vessels

Eccentric T1 signal demonstrated within the left internal carotid artery commencing at the level of the C2 vertebral body extending to the proximal petrous portion with associated luminal narrowing consistent with dissection. Minor T1 hyperintensity surrounding the mid to distal petrous portion of the left ICA which may represent some minor extension of the dissection.

Case Discussion

Classic CT and MRI features of internal carotid artery dissection with eccentric luminal narrowing surrounded by mural thrombus. Crescent sign demonstrated on the MRI.

This patient presented with a sudden onset unilateral retro-orbital headache which was later associated with left-sided miosis and ptosis in keeping with Horner's syndrome. No infarct identified. No other pathology present accounting for the patient's symptoms.

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Case information

rID: 81903
Published: 16th Sep 2020
Last edited: 17th Sep 2020
System: Head & Neck
Inclusion in quiz mode: Excluded

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