MRA Neck
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0411-MRA Neck

CA0411-MRA Neck
Case ReportExam
Prior Study
1. Acute thrombus in the high cervical and vertical intrapetrous segments of the left cervical ICA without evidence of acute cerebral stroke. The history of acute upper neck pain makes dissection a very likely possibility.
2. Head is negative for hyperacute stroke changes.
Findings
MRA of the neck
The right carotid, both vertebral arteries, and the left common carotid including the bifurcation are normal in appearance.
The high-cervical left ICA has evidence of acute mural thrombus surrounding the ICA lumen extending over several centimeters consistent with arterial dissection. The width of the mural thrombus is minimal in the proximal ICA, but becomes more bulky toward the skull base. The ICA lumen becomes progressively narrowed as the thrombus becomes larger. Thrombus fills the vertical intrapetrous segment ICA canal corresponding to a flow void within the genu portion of the ICA.
Shortly after the occluded left ICA segment, patency of the artery returns creating a distinct interface between the thrombus and patent cavernous ICA lumen. The patency of the horizontal segment left ICA is likely related to patent EC-IC collateral; there could be some antegrade flow present, but it is not evident by MRA. Nevertheless, the size of the ICA beyond the apparent occlusion is nearly normal indicating reasonably good flow volume; there is no distal arterial collapse.
With evidence of clot within the left ICA lumen, the possibility of thromboembolism is very possible.
Impression
2. Given a history of seizures, this spontaneous left ICA dissection may have been the result of a recent grand mal type of seizure (i.e. traumatic origin). There is no other underlying vasculopathy evident to predispose to dissection.