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This patient presented with right-sided headache,

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dizziness, and transient visual loss.

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Although the CT scan for the head was negative,

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they proceeded with a CT study of the neck with CT

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angiographic technique in order to exclude a

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vascular etiology. So what you're seeing is a CTA,

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which is optimized for the arteries,

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but in addition,

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we are seeing some jugular vein opacification.

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But this was supposed to be an arteriogram.

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And if we start down below,

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as we normally would expect to,

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we're dealing with the right side.

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So this is the right common carotid artery,

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and we're going to follow it up.

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So we're just going to look at that one vessel,

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and as we proceed superiorly,

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not be alarmed by the jugular vein,

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which is showing some heterogeneous enhancement.

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That's all based on timing.

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We're continuing up the right common carotid artery,

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keeping our eyes on that blood vessel,

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and we come to the carotid bifurcation.

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So at the carotid bifurcation, the lumen looks good.

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This is now the external carotid artery and the

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internal carotid artery and the partially

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opacified jugular vein.

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We have the contralateral carotid bifurcation,

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which looks fine.

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We proceed focusing on the internal

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carotid artery on the right side.

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And what you notice as we come towards the skull

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base is that the blood vessel starts to have a

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smaller lumen on the right side

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compared to the left.

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And if we continue further superior,

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we see something that is occurring in the medial

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wall of the right internal carotid artery.

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What you're seeing is this low-density material,

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which again elongates the carotid artery in an AP

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plane. And as we continue further superiorly,

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we're seeing that there's a greater and greater

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difference between the caliber of the lumen of the

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right internal carotid artery versus the caliber of

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the lumen of the left internal carotid artery.

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And this gets worse and worse.

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You can see now we're having very little

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opacification of that right distal cervical internal

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carotid artery compared to the left.

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As we scroll further,

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we come to the petrous internal carotid artery canal

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normal on the left seen with normal lumen.

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On the right,

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we have just a little sliver of the internal carotid

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artery. But at the petrous port horizontal portion,

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it reconstitutes and we have

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a more normal appearance

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of the cavernous internal carotid artery.

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So going back again,

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cavernous internal carotid artery,

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petrous distal cervical. At the petrous junction,

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we have the luminal irregularity

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and almost complete occlusion.

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So this is an example of a patient who has a

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dissection of the internal carotid artery in the wall,

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which is in the distal internal carotid artery,

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cervical portion, and proximal petrous portion.

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And this was the source of the patient's headache

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and neck pain from the dissection.