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Dissection extending from extra- to intracranial arteries: A case report of progressive ischemic stroke
Fu-Liang Zhang1, Zhen-Ni Guo, Yang Liu
1Stroke Center Neuroscience Center, Department of Neurology Department of Radiology, the First Hospital of Jilin University, Chang Chun, China.
Insights
Cervicocephalic artery dissection is a growing cause of stroke in younger adults. 3D fat-saturated T1 VISTA imaging aids diagnosis and follow-up, though distinguishing certain features remains challenging.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Cervicocephalic artery dissections are increasingly recognized as a cause of stroke in young and middle-aged individuals.
- Early diagnosis is crucial for preventing ischemic events through anticoagulation or antithrombotic therapy.
- Accurate diagnosis remains a significant challenge for clinicians.
Observation:
- A rare case of a 33-year-old patient with progressive ischemic stroke due to dissection of the right internal carotid artery extending to the middle cerebral artery was reported.
- 3D fat-saturated T1 VISTA imaging provided comprehensive coverage and high resolution of the dissected arterial segments, including both extra- and intracranial portions.
- The patient was treated with clopidogrel and rehabilitation training, leading to gradual symptom improvement.
Findings:
- 3D fat-saturated T1 VISTA imaging proved beneficial for diagnosing and monitoring cervicocephalic artery dissection complicated by progressive ischemic stroke.
- The technique allowed for detailed visualization of the dissected arterial segments.
- However, differentiating between intramural hematoma and intraluminal thrombus in cases of acute occlusion without typical dissection features remains difficult with this method alone.
Implications:
- 3D fat-saturated T1 VISTA imaging is a valuable tool in the diagnosis and follow-up of cervicocephalic artery dissections.
- Further research into optimized VISTA techniques is needed to definitively diagnose challenging cases, such as acute occlusions.
- Improved diagnostic accuracy can lead to timely and effective treatment, potentially reducing stroke-related morbidity.
Rationale:
Cervicocephalic artery dissections, once considered a rare disease, have become increasingly recognized as a cause of stroke in young and middle-aged individuals. Early diagnosis is mandatory because anticoagulation or antithrombotic therapy can help prevent primary or secondary ischemic events. However, the diagnosis is still a crucial challenge for radiologists and neurologists.
Patient Concerns:
We reported a rare case of 33-year-old patient with progressive ischemic stroke due to dissection from an intimal tear in the right proximal internal carotid artery to distal middle cerebral artery.
Diagnoses:
3D fat-saturated T1 VISTA imaging, owing to its comprehensive neck and head coverage, high spatial resolution, enables the reader to have several sections with good contrast covering the dissected arterial segment, even in the rare dissection involving extra- and intra-cranial arteries referred in this article.
Interventions:
Clopidogrel 75mg daily was prescribed, also the patient was given rehabilitation training.
Outcomes:
His symptoms improved gradually.
Lessons:
We describe that 3D fat-saturated T1 VISTA was helpful for the diagnosis and follow-up in our case of cervicocephalic artery dissection complicated with progressive ischemic stroke. However, for totally acute occlusion of the artery without typical features of dissection, the unequivocal distinction between intramural haematoma and intraluminal thrombus may still be difficult with 3D fat-saturated T1 VISTA alone. Future studies should investigate whether an optimal VISTA technique would be useful for making a definite diagnosis.
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