38 years, Female, constant headache for 3 weeks. There is evidence of dissection involving the distal right cervical internal carotid artery with presence of dissection flap and narrowing of the lumen. There is T1 hyperintensity related to the mural thrombus. Flow-void of the right cervical internal carotid artery is narrowed related to the dissection. The flow-void of the cavernous and supraclinoid internal carotid artery is normal in caliber. Brain parenchyma appears unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. There is dissection involving the visualized portion of the distal right cervical internal carotid artery. There is narrowing of the adjacent right ICA flow-void without occlusion. CTA or MRA head and neck can better assess the full extent of the dissection although cranially appears to extend to the level of the petrous ICA segment.2. Brain MRI is otherwise unremarkable. No evidence of infarct or intracranial mass. Dr. Ali discussed findings with Dr. Vela at 1025 hours on 6/1/2016