FINDINGS: Approximately 2.5 cm distal to the left carotid bifurcation, the lumen of the internal carotid artery (ICA) tapers significantly with extremely poor opacification of the remainder of the vessel. A string sign is visualized. The preterminal segment of the ICA is again opacified, yet poorer than on the right side.
The remainder of the brain-supplying and intracerebral arteries appear normal. The right ICA has a unusual, very tortuous course before entering the skull base.
Bilateral cervical lymphadenopathy is noted. Degenerative changes of the cervical spine with multisegmental intervertebral disc degenerative disease and intervertebral disc vacuum phenomena.
CONCLUSION: Left internal carotid artery dissection approximately 2.5 cm distal to the carotid bifurcation.