Extracranial internal carotid artery dissection secondary to neck massage: visualization of mural hematoma by MRI

A 52-year-old man was admitted due to a severe pain in the right side of the neck and a progressive weakness of the left-side extremities. One week prior to admission, the patient began to use massage balls to relieve his long-lasting nuchal soreness. Carotid arteriography revealed a segment of tapered stenosis of the extracranial internal carotid artery with distal occlusion at the proximal middle cerebral artery. Magnetic resonance imaging (MRI) demonstrated a well-defined mural hematoma which is a distinctive feature of arterial dissection.