Carotid arterial dissection with acute cerebral infarction

Case contributed by Dr Mohammad A. ElBeialy


A 50-year-old man with recent onset of headache and neck pain presents with acute left-sided hemiplegia.

Patient Data

Age: 50 years
Gender: Male
  • a large right fronto-temporo-parietal cortical and subcortical area of restricted diffusion (high DWI, low ADC signal)
  • lesion shows mild T1 hypointensity as well as high T2/FLAIR signal intensity
  • 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
  • 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:
    • 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

Case Discussion

Right distal cervical ICA dissection with intramural haematoma and resultant right fronto-temporo-parietal acute cerebral infarction.

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Case information

rID: 26636
Case created: 31st Dec 2013
Last edited: 8th Mar 2018
Inclusion in quiz mode: Included

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