Clinical Review & Education
Images in Neurology
Diagnosis of Cervical Artery Dissection Using 3-T Magnetic Resonance Imaging Fu-liang Zhang, MD; Yang Liu, MD; Ying-qi Xing, MD, PhD; Yi Yang, MD, PhD
A previously healthy woman in her 30s presented to the Department of Neurology at First Norman Bethune Hospital of Jilin University with thunderclap neck pain that radiated to the left occiput for 4 days after working for a long time at a computer with lateroversion of the neck. On neurologic examination, there were no other findings but a left Horner syndrome.1 The results from routine hematologic and biochemical tests and computed tomographic brain scan were all normal. The curved planar reformation images from computed tomographic angiography showed tapering stenosis of the left internal carotid artery beginning 2 to 3 cm distal to the bifurcation and extending almost into the skull base (Figure, A). Further investigation of her symptoms was performed to identify the cause of the stenosis.
Discussion Volumetric isotropic turbo spin echo acquisition (VISTA) is a 3-dimensional turbo spin echo magnetic resonance imaging method using nonselective refocusing pulses. It can reveal mural hematomas as hyperintense surrounding the arterial lumen, with great contrast to the dark vessel lumen and surrounding tissues, and enable assessment for arterial vessel stenosis. T1-weighted VISTA magnetic resonance imaging investigation of this patient showed a crescentic high signal of the left internal carotid artery that suggested intramural hematoma, indicating left internal carotid artery dissection (Figure, B). Aspirin was prescribed, and her symptoms gradually improved. A repeated T1weighted VISTA magnetic resonance image performed 3 months later showed recanalization of the left internal carotid artery (Figure, C).
Figure. Radiologic Features of Left Internal Carotid Artery Before and After Therapy A
B
A, The curved planar reformation images of computed tomographic angiography show tapering stenosis of the left internal carotid artery beginning 2 to 3 cm distal to the bifurcation and extending almost into the skull base. B, The T1-weighted volumetric isotropic turbo spin echo acquisition magnetic
600
C
resonance imaging reveals a crescentic hyperintensity of the left internal carotid artery. C, A repeated T1-weighted volumetric isotropic turbo spin echo acquisition magnetic resonance image 3 months later indicates recanalization of the left internal carotid artery.
JAMA Neurology May 2015 Volume 72, Number 5 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
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jamaneurology.com
Images in Neurology Clinical Review & Education
ARTICLE INFORMATION Author Affiliations: Neuroscience Center, Department of Neurology, The First Norman Bethune Hospital of Jilin University, Chang Chun, China (Zhang, Xing, Yang); Department of Radiology, The First Norman Bethune Hospital of Jilin University, Chang Chun, China (Liu).
Corresponding Author: Yi Yang, MD, PhD, Neuroscience Center, Department of Neurology, The First Norman Bethune Hospital of Jilin University, Xinmin St 71, 130021 Changchun, China ([email protected]). Accepted for Publication: December 15, 2014.
Conflict of Interest Disclosures: None reported. REFERENCE 1. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001; 344(12):898-906.
Published Online: March 23, 2015. doi:10.1001/jamaneurol.2014.4589.
Announcement The American Neurological Association is having a satellite symposium “Circuits and Circuit Disorders: Approaches to Neuromodulation,” Saturday, September 26, 2015, 7:00 PM, Marriott Downtown Hotel, Chicago, Illinois, the evening before the start of the annual meeting. It is cosponsored by the Annals of Neurology and JAMA Neurology and features Mahlon Delong, MD, Emory University, 2014 Lasker Prize in Medicine recipient for his research in developing deep brain stimulation; Philip Starr, MD, PhD, University of California, San Francisco, the dystonias; Jonathan Mink, MD, PhD, University of Rochester Medical Center, Tourette syndrome; Helen Mayberg, MD, Emory University, depression; and Bryan L. Roth, PhD, University of North Carolina, chemogenetics. Registration for the meeting and hotel accommodations can be obtained at http://myana.org/events/ana-2015-annual-meeting.
jamaneurology.com
(Reprinted) JAMA Neurology May 2015 Volume 72, Number 5
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a Fudan University User on 05/16/2015
601
Images in Neurology
Diagnosis of Cervical Artery Dissection Using 3-T Magnetic Resonance Imaging Fu-liang Zhang, MD; Yang Liu, MD; Ying-qi Xing, MD, PhD; Yi Yang, MD, PhD
A previously healthy woman in her 30s presented to the Department of Neurology at First Norman Bethune Hospital of Jilin University with thunderclap neck pain that radiated to the left occiput for 4 days after working for a long time at a computer with lateroversion of the neck. On neurologic examination, there were no other findings but a left Horner syndrome.1 The results from routine hematologic and biochemical tests and computed tomographic brain scan were all normal. The curved planar reformation images from computed tomographic angiography showed tapering stenosis of the left internal carotid artery beginning 2 to 3 cm distal to the bifurcation and extending almost into the skull base (Figure, A). Further investigation of her symptoms was performed to identify the cause of the stenosis.
Discussion Volumetric isotropic turbo spin echo acquisition (VISTA) is a 3-dimensional turbo spin echo magnetic resonance imaging method using nonselective refocusing pulses. It can reveal mural hematomas as hyperintense surrounding the arterial lumen, with great contrast to the dark vessel lumen and surrounding tissues, and enable assessment for arterial vessel stenosis. T1-weighted VISTA magnetic resonance imaging investigation of this patient showed a crescentic high signal of the left internal carotid artery that suggested intramural hematoma, indicating left internal carotid artery dissection (Figure, B). Aspirin was prescribed, and her symptoms gradually improved. A repeated T1weighted VISTA magnetic resonance image performed 3 months later showed recanalization of the left internal carotid artery (Figure, C).
Figure. Radiologic Features of Left Internal Carotid Artery Before and After Therapy A
B
A, The curved planar reformation images of computed tomographic angiography show tapering stenosis of the left internal carotid artery beginning 2 to 3 cm distal to the bifurcation and extending almost into the skull base. B, The T1-weighted volumetric isotropic turbo spin echo acquisition magnetic
600
C
resonance imaging reveals a crescentic hyperintensity of the left internal carotid artery. C, A repeated T1-weighted volumetric isotropic turbo spin echo acquisition magnetic resonance image 3 months later indicates recanalization of the left internal carotid artery.
JAMA Neurology May 2015 Volume 72, Number 5 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a Fudan University User on 05/16/2015
jamaneurology.com
Images in Neurology Clinical Review & Education
ARTICLE INFORMATION Author Affiliations: Neuroscience Center, Department of Neurology, The First Norman Bethune Hospital of Jilin University, Chang Chun, China (Zhang, Xing, Yang); Department of Radiology, The First Norman Bethune Hospital of Jilin University, Chang Chun, China (Liu).
Corresponding Author: Yi Yang, MD, PhD, Neuroscience Center, Department of Neurology, The First Norman Bethune Hospital of Jilin University, Xinmin St 71, 130021 Changchun, China ([email protected]). Accepted for Publication: December 15, 2014.
Conflict of Interest Disclosures: None reported. REFERENCE 1. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001; 344(12):898-906.
Published Online: March 23, 2015. doi:10.1001/jamaneurol.2014.4589.
Announcement The American Neurological Association is having a satellite symposium “Circuits and Circuit Disorders: Approaches to Neuromodulation,” Saturday, September 26, 2015, 7:00 PM, Marriott Downtown Hotel, Chicago, Illinois, the evening before the start of the annual meeting. It is cosponsored by the Annals of Neurology and JAMA Neurology and features Mahlon Delong, MD, Emory University, 2014 Lasker Prize in Medicine recipient for his research in developing deep brain stimulation; Philip Starr, MD, PhD, University of California, San Francisco, the dystonias; Jonathan Mink, MD, PhD, University of Rochester Medical Center, Tourette syndrome; Helen Mayberg, MD, Emory University, depression; and Bryan L. Roth, PhD, University of North Carolina, chemogenetics. Registration for the meeting and hotel accommodations can be obtained at http://myana.org/events/ana-2015-annual-meeting.
jamaneurology.com
(Reprinted) JAMA Neurology May 2015 Volume 72, Number 5
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archneur.jamanetwork.com/ by a Fudan University User on 05/16/2015
601
