CASE 1973 Published on 17.11.2005

Internal carotid artery dissection: MRI appearance

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Pallan A, Vydianath SR, Chavda SV

Patient

52 years, female

Categories
No Area of Interest ; Imaging Technique MR
Clinical History
A 52-year-old male patient with a recent thrombolysed myocardial infarction presented with a new, sudden onset of headache and left-sided Horner's syndrome.
Imaging Findings
The patient presented with a history of acute left-sided blurred vision, dysgeusia and headache, three weeks after a myocardial infarction for which she had been thrombolysed. On examination, there was a persistent left-sided partial ptosis and miosis found. No other neurological deficit was identified. An MRI examination of her neck was carried out, primarily to assess her carotid arteries.
Discussion
The dissection of the internal carotid artery (ICA) is one of the cmost common causes of strokes within the young and middle-aged population. The dissection may have a traumatic or non-traumatic aetiology. In the case of traumatic dissections, the dissectionmay be due to a significant trauma such as which occurs in road traffic accidents, contact sports or accidental hanging, or an apparently non-significant trauma with cases involving skiing, running or diagnostic carotid compression being described. In many instances, the trauma may have been so minor that it may not be recollected. With non-traumatic dissection, the aetiologies include fibromuscular dysplasia, Marfan's syndrome and cystic medial necrosis. Other associations are hypertension, smoking and migraine. The presentation is most commonly with a headache, which may be maximal on the side of the affected vessel. Due to the intimate relationship of the cervical sympathetic pathway to the ICA, there may also be features of Horner's syndrome (enophthalmos, ptosis, miosis, and anhydrosis). Features of dysgeusia, neck pain, amaurosis fugax, TIA or a complete stroke may predominate. The most common site of CA dissection is in the ICA within a few centimetres of the carotid bifurcation, with the supraclinoid part of the ICA being the most common intracranial site. A dissection of the carotid arteries is twice as common as a dissection of the vertebral arteries. The diagnosis may be made using MRI, CT, conventional angiography or US techniques, with MR being the preferred modality of diagnosis. Axial T1-weighted fat-saturated images from the neck to the cavernous sinus are used. MR angiography may be useful in the very acute stages only.
Differential Diagnosis List
Left internal carotid artery dissection.
Final Diagnosis
Left internal carotid artery dissection.
Case information
URL: https://www.eurorad.org/case/1973
DOI: 10.1594/EURORAD/CASE.1973
ISSN: 1563-4086