Intracranial vessel wall MR imaging of an intradural vertebral artery dissection

Diagnosis of intracranial arterial dissections can be challenging due to the wide spectrum of imaging presentations. High-resolution vessel wall MR imaging can be a useful adjunct to conventional lumen-based imaging techniques for diagnosing arterial dissections. We present a case of a 37-year-old male with a history of a Wolff-Parkinson-White syndrome presenting with acute onset of nausea, vertigo, and left body hemisensory loss of pain and temperature. A conventional brain MRI identified an acute infarct in the right lateral medulla, concordant with clinical symptoms of Wallenberg syndrome. CT angiogram of the head and neck showed lack of opacification of the right intradural vertebral artery. Intracranial vessel wall MR imaging showed findings suggestive of an intimal dissection flap with both intramural and intraluminal thrombus. Intracranial vessel wall MR imaging can provide complementary information to conventional lumen-based imaging to diagnose a vertebral dissection.