Head and Neck ImagingInternal carotid artery dissection
splitting or
dissection of the internal carotid arterial wall by a mural
haematoma. Such a
dissection often occurs spontaneously and is mainly seen in middle aged patients. It usually starts about 2 cm distal to the carotid bifurcation, and may extend up to the skull base, the carotid canal or even into the cavernous
sinus. The most frequent symptom is ipsilateral headache, usually frontotemporal. Other symptoms may be associated, such as
Horners syndrome and paralysis of an upper cranial nerve. The diagnosis can be suspected on
ultrasound and confirmed by
angiography, but is also readily made on axial MR images: the internal carotid
artery appears enlarged and shows a high signal intensity zone, corresponding to the mural
haematoma, eccentrically situated with respect to the
lumen if this is not completely occluded (
Fig.1).
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Patient with left-sided headache and hypoglossal nerve paralysis. On an axial T1-weighted spin-echo image, the left internal carotid artery appears enlarged in its transverse diameter. The hyperintense signal (arrowheads) surrounding the true lumen corresponds to mural haematoma.
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Internal carotid artery dissection, Fig.1 | |