0:01

Let's take a quick look at this case.

0:03

Here we have the common carotid arteries coming up. In a patient

0:08

who had strangely a bilateral Horner syndrome, actually going

0:13

downward. But let's go back up and if we watch the left side,

0:18

we see the carotid bifurcation and we see a little

0:22

bit of irregularity to the internal carotid artery.

0:25

Is there a flap already here across the carotid?

0:29

Here we see just irregular blood vessel without pouching, that

0:35

should not be the normal lumen of the internal carotid artery.

0:38

Here we can see a nicely demonstrated flap on the left

0:41

side. And then we continue up into the petrous portion.

0:45

But even here, the vessel is all irregular, showing

0:49

areas of narrowing and internal arch-

0:53

Here's another area of dissection.

0:56

And then we get into the petrous portion, which looks

0:58

a little bit more normal. On the right side,

1:02

a funny-looking shape in the petrous portion compared to

1:05

the contralateral, so it's probably not a normal vessel.

1:09

Here we have an outpouching of the internal

1:12

artery just as it enters the petrous portion.

1:15

Here's a nice flap across the enlarged lumen of the right

1:21

internal carotid artery. Here it gets quite narrow, winds out

1:24

again, irregular shape. And here's another area of a flap.

1:28

So as you talk about multiple flaps and

1:30

areas of narrowing and widening,

1:32

it should come to mind the possibility that

1:35

the patient has fibromuscular dysplasia.

1:38

That's pretty typical of areas of luminal narrowing and

1:42

widening associated with patients who have dissection.

1:46

And this sort of kinky look to the internal carotid artery with

1:52

the string of pearls or the accordion look to it, is very

1:56

typical a fibromuscular dysplasia, which has the

1:59

complications of dissection and pseudoaneurysm.

2:02

Look at again these multiple rings of narrowing as well as

2:07

widening associated with the internal carotid artery.

2:11

Let's see whether it's even better seen on the sagittal

2:14

scan here. This is not even the vertebral artery,

2:18

as you can see, has that same serrated area

2:22

look to it, that's associated with fibromuscular dysplasia.

2:28

Really awful looking blood vessel.

2:30

Let's look on the other side.

2:33

Widening, narrowing, widening,

2:36

tortuosity, dissection, vertebral artery, not so bad on this side.

2:43

So if you have the case of bilateral fibromuscular

2:47

dysplasia, particularly in a patient who is non traumatic,

2:51

you may see bilateral dissections,

2:53

bilateral areas of narrowing

2:55

and widening in this

2:58

string of pearls type of appearance.

Case 11 - Bilateral Dissection

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