FIGURE 1.
Sagittal (A) and axial (C) CT angiography (CTA) images show a right common carotid artery dissection (circled in red), evidenced by intimal irregularity. Additional sagittal (B) and axial (D) CTA images demonstrate a left internal carotid artery dissection (circled in yellow), featuring a long segmental dissection with potential occlusion of the distal cervical portion near the vertical petrous segment.
FIGURE 2.
Oblique (A) and lateral (B) angiographic images of the left internal carotid artery show a patent origin but demonstrate a focal area of severe stenosis in the distal cervical segment, with approximately 91% narrowing as per the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, leading to distal flow delay. The left external carotid artery is patent at its origin, and the visualized portions of the external carotid artery and its branches appear normal without signs of ulceration or stenosis. No evidence of arteriovenous shunting is noted.
FIGURE 3.
Anterior/posterior (A) and lateral (B) angiographic images of the right common carotid artery reveal two focal areas of dissection (circled in red) with raised intimal flaps, with the distal dissection located just proximal to the carotid bifurcation. The right external carotid artery is patent at its origin, and the right internal carotid artery (ICA) shows no evidence of injury (B). Visualized segments of the external carotid artery and branches appear normal without signs of ulceration or stenosis. The distal cervical and intracranial segments of the right ICA demonstrate normal filling without occlusion or stenosis.
FIGURE 4.
(A) Diffusion-weighted imaging (DWI) reveals multiple small infarcts scattered throughout the white matter in both the right and left cerebral hemispheres, which are confined to the anterior circulation. (B) The apparent diffusion coefficient (ADC) matches some of these infarcts, suggesting their acute nature. (C) Susceptibility-weighted imaging (SWI) indicates a single right frontal lesion. All of the acute infarcts seen on DWI/ADC are non-hemorrhagic, confirming an embolic rather than hemorrhagic origin.
FIGURE 5.
(A) FLAIR imaging reveals abnormal hyperintensity in the bilateral white matter, indicating areas of potential tissue injury or edema. (B) T2-weighted imaging further emphasizes these regions, highlighting the same areas of hyperintensity in the bilateral white matter.