A somewhat tragic case. A middle-aged patient with no prior neurological pathologies was brought to a small hospital after a motor vehicle accident, a facility that was not equipped to handle trauma patients in the first place. The reasons for that are unknown to the author.

Secondly, the patient discharged himself against medical advice. Some hours later he developed neurological symptoms. The patient could have been treated earlier had he stayed in a suitable medical facility and maybe such severe damage to the brain could have been reduced by earlier intervention.

Thirdly, due to the tortuous course of the patient's ICA, the vessel was prone to traumatic injury, in this case likely due to the seat belt which might have cut into the patient's left neck during the accident.

Image-wise, classic signs of a carotid dissection can be seen on CTA, namely the string sign, and on MRI, the crescent sign within the wall of the vessel.