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A 42 year-old man developed the abrupt onset of a left hemiparesis.
(Left) Right Carotid Angiogram at the level of the carotid bifurcation; (Middle) Right Internal Carotid Angiogram, lateral view; (Right) Right Internal Carotid Angiogram, AP view. Note on the angiogram the abrupt tapering and occlusion of the internal carotid artery. This is one of the classic appearances of a dissection. On the intracranial internal carotid angiograms, note the complete absence of the middle cerebral artery. The anterior cerebral artery is well seen, as are the lenticulostriates. Presumably, the dissection resulted in an artery to artery embolus that lodged in the distal MCA stem.
The Electronic Curriculum is copyrighted 1998, Case Western Reserve University School of Medicine.