Carotid artery dissection, case 2

Posttraumatic cervical internal carotid artery dissection, 1.5 T.
This 45 year old male presented with retroorbital pain and myosis of the right eye following cervical trauma. At admission, no other neurological signs were noted.
The initial CT scan of the brain was normal. MRA was elected as a screening technique to rule out a lesion of the cervical arteries and revealed a dissection of the right internal carotid artery. The patient was treated with systemic anticoagulation.

Fig.1 The sagittal targeted MIP reconstruction of the right internal carotid artery from a 3D TOF acquisition data set suggests the presence of a true lumen, anteriorly located within the internal carotid artery, exhibiting a higher intravascular signal, and a false lumen posteriorly, characterized by less intense and somewhat inhomogeneous signal (arrows). The true and the false lumens are separated by a thin linear hypointense structure, consistent with the intimal flap.

Fig. 2 The transverse source images of the 3D TOF acquisition demonstrate the typical appearance of dissection of the cervical internal carotid artery, consisting of the subintimal thrombus (blue arrows) and the residual lumen (red arrow) with the intimal flap between the two (yellow arrows).

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