internal carotid artery dissection radiological findings

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1、InternalCarotidArteryDissection:RadiologicalFindingsLauraRosow,HMSIVGillianLieberman,MDBIDMCAdvancedClerkshipinRadiologyMarch16,2010Outline1.Patientpresentation2.Overviewofinternalcarotidartery(ICA)anatomyandthepathophysiologyofdissection3.Menuofradiologictests4.Differentialdiagnosi

2、sOurPatient,J.M.ID/CC:48F,“sinusinfection”HPI:•Right-sidedfacialpainx7days•PCPdiagnosedsinusinfection,prescribedazithromycinnoimprovementinpain•1daypriortopresentation,developeddiffuseheadacheand“whooshing,”“fluttering”sensationsinrightear•WenttoBIDNeedhamERAcontrast-enhancedCTofth

3、efacialbonesandparanasalsinuseswasperformed.PatientJM:Contrast-EnhancedCTAxialC+HeadCTPACS,BIDMC“Noevidenceofsinusdisease,abscess,ororbitalcellulitis.”PatientJM:ICAsonCTRightICALeftICAAxialC+HeadCTPACS,BIDMCPatientJM:MarkedstenosisoftheRightICAonCT?Periluminalthrombus*Stenoticarteri

4、allumenAxialC+CTPACS,BIDMCPatientJM:FurtherWorkupandManagementJMwastransferredtotheneurologyserviceatBIDMCforadditionalimagingandmanagement.Ontakingadetailedhistory,itwaslearnedthatJMhadundergonecervicalchiropracticmanipulationthedaypriortodevelopingherheadache.Onexamination,shewasn

5、ownotedtohaveamarkedrightHorner’ssyndrome(ptosis/miosis).UpToDateTMAnMRI/MRAoftheheadandneckwasperformed.PatientJM:MRIFindingsofDissectionIncreasedsignalwithinrightICAconfirmsperiluminalhematoma(diagnosticofdissection)SmallluminalopeningPatentleftICAAxialC+T1Fat-SaturatedMRIHead/Nec

6、kPACS,BIDMCPatientJM:Three-DimensionalReformattedMRISuperiorextentoflesionInferiorextentoflesionCarotidbifurcationCoronalPost-gadolinium3DReformattedMRIHead/NeckPACS,BIDMCPatientJM:FurtherManagementFurtherreviewofJM’sheadMRIwasnegativeforinfarctorhemorrhage.Shewasstartedonwarfarinwi

7、thaheparinbridge.After48hoursofmonitoring,JMwasdischargedwithplansforcarefulfollow-up.At6weekspost-discharge,acarotidultrasoundwasperformed…PatientJM:Follow-upCarotidUltrasoundSagittalCarotidDuplexUltrasoundNormalflowvelocitiesthroughouttherightinternalcarotidarterysuggestthatithass

8、uccessfullyrecanali