Internal Carotid Artery Dissection in a 41 year old male with Headache

The dissection was not identified on the limited 3 sequence review. Sagittal T1-weighted image (A) shows narrowing of the distal cervical portion of the right internal carotid artery with T1 hyperintense intramural hematoma (white arrow). Axial FLAIR image (B) demonstrates loss of the normal right internal carotid artery flow void (white arrow), which is more conspicuous on the axial T2-weighted image (D). Axial diffusion weighted trace image (C) shows no restricted diffusion in the region of the right internal carotid artery. Axial pre-contrast T1-weighted image (E) demonstrates an eccentric T1 hyperintense intramural hematoma (white arrow) in the distal cervical right internal carotid artery. MR angiography maximum intensity projection images reveal irregular critical narrowing (white arrow) of the distal cervical right ICA (F) and asymmetrical flow-related signal in the right intracranial ICA (G).