scanman’s casebook: Case 13

Published by Vijay March 20th, 2009 in Brain, CT, Radiology, casebook

CT Angiography shows severe narrowing of the distal cervical, intracanalicular and supraclinoid segments of left Internal Carotid artery with non-visualized terminal segment and its bifurcation. Left Middle Cerebral artery and A1 segment of left Anterior Cerebral artery are not seen. A2 & A3 segments of left ACA are normal.

Diagnosis: Internal Carotid artery dissection with acute cerebral infarction (MCA territory)

Carotid artery dissection is a significant cause of ischemic stroke in all age groups.Spontaneous internal carotid artery dissection is a common cause of ischemic stroke in patients younger than 50 years and accounts for up to 25% of ischemic strokes in young and middle-aged patients. Dissection of the internal carotid artery can occur intracranially or extracranially, with the latter being more frequent. Internal carotid artery dissection can be caused by major or minor trauma, or it can be spontaneous in which case genetic, familial, and/or heritable disorders are likely etiologies. Patients can present in a variety of settings, such as a trauma bay with multiple traumatic injuries; their physician’s office with nonspecific head, neck, or face pain; or to the emergency department with a partial Horner syndrome. A high index of suspicion is required to make this difficult diagnosis. Sophisticated imaging techniques, which have improved over the last two decades, are required to confirm the presence of dissection.

Further Reading:

1. Case of Carotid Dissection with stroke at Radiopaedia.org - completely worked up with plain CT, DW MRI, CT Perfusion & DSA images.
2. Dissection, Carotid Artery - article in Medscape Radiology [Registration required, Free]
3. Acute Cerebral Infarction - case in BrighamRad.