Case 3

This is an MRI brain study showing an eccentric, crescent shaped high T1 signal surrounding the cervical segment of the left internal carotid artery, which is most visible on the T1 fat saturated series. The TOF series shows significant luminal stenosis of this segment of the artery.

These findings indicate a dissection of the internal carotid artery.

There is no associated acute brain infarction.

Incidentally, the right vertebral artery is markedly hypoplastic with persistent foetal circulation of the right posterior cerebral artery. Another incidental finding is a vascular structure in the right cerebellar hemisphere resembling a palm tree, which represents a developmental venous anomaly.

I would urgently contact the referring physician as this constitutes an emergency, and recommend urgent referral to the neurology service.