Internal carotid artery dissection

There is a focal segment of the distal cervical portion of the left internal carotid artery of about 1.9 cm in length that shows a circular T1 and T1 fat sat and a T2/DWI hyperintense signal with diffuse attenuation of the left internal carotid artery, suggesting focal arterial dissection with intramural hematoma.

The right vertebral artery shows a crescent-shaped focus extending from the level of C5 to the level of C2 transverse foramen, measuring about 5.5 cm in length, suggesting a long segment of right vertebral artery dissection.

Few nonspecific bilateral and T2/FLAIR hyperintensities were seen involving the periventricular and subcortical white matter without diffusion restriction or mass effect.

There is no restricted diffusion to suggest an acute infarction.

The distal cervical portion of the left internal carotid shows a short segment of a small intimal flap with pseudo-aneurysmal dilatation, a narrowed eccentric lumen surrounded by a crescent-shaped hyperattenuating focus measuring about 2 cm in length, suggesting left internal carotid artery dissection in keeping with the patient's MRI findings.

The right vertebral artery shows wall thickening in its proximal part past its insertion as well as pseudo-aneurysmal dilatation with a narrowed eccentric lumen surrounded by a crescent-shaped focus extending from the level of C5 to the level of C2 transverse foramen measuring about 5.5 cm in length, suggesting long segment right vertebral artery dissection.