Internal carotid artery dissection

Traumatic cervical internal carotid artery dissection.
This 38 year old male had severe neck trauma and was unconscious upon admission. After hospitalization the patient regained consciousness and demonstrated transient left hemiparesis and homonymous hemianopia.
After hospital admission a C2 fracture was discovered. Neurological examination disclosed a right sided Horner's syndrome (ptosis, myosis, enophthalmos) [38].
CT examination demonstrated ischemic lesions in the basal ganglia (corresponding to the vascular territory of the anterior choroidal artery) and in the occipital region in the right hemisphere. Injury to the right internal carotid artery was suspected and emergency selective cerebral angiography was performed confirming the presence of internal carotid artery dissection. The clinical course was favorable and the patient was treated with oral anticoagulation.
Follow-up conventional cerebral angiography was performed three months later and showed recanalization in conjunction with the formation of a pseudoaneurysm at the level of the previous dissection. Follow-up of the pseudoaneurysm was scheduled by MRA.

Fig.1 DSA images (a-p view) of the right internal carotid artery in the acute phase after the dissection (left) and at the 3-month follow-up examination (right).

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