Migrainous Spasm Simulating Carotid Dissection: A Pitfall in MR Arteriographic Findings
Po Ping Iua and
Hon Shing Lama
a From the Department of Radiology (P.P.I, H.S.L.), Kwong Wah Hospital, Kowloon, Hong Kong.
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FIG 1. Images from first session with a head coil show suspicion of carotid dissection.
A, Source image shows little flow in the left internal carotid artery as compared with the right side.
B, Maximum intensity projection image shows decrease in flow in the left internal carotid, the left middle cerebral, and anterior cerebral arteries.
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FIG 2. Images from first session with a head-neck coil show return of flow in the left internal carotid artery within minutes.
A, Source image shows equal flow in the right and left carotid siphons.
B, Maximum intensity projection image shows complete patency of the carotid arteries including the siphons.
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FIG 3. Images from 2 days after first session on a head coil shows equal flow in the right and left anterior and middle cerebral arteries
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FIG 4. Diffusion-weighted image with ADC map shows restricted diffusion on left middle cerebral artery territory.
A, Diffusion-weighted image with b = 1000 T shows increased intensity over the left middle cerebral artery territory.
B, The ADC map shows decreased diffusion over middle cerebral artery territory as low signal intensity.
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AJNR - American Journal of Neuroradiology