Teaching NeuroImages: Simultaneous angiography and ultrasonography in extracranial internal carotid artery dissection

A 26-year-old woman was admitted with amaurosis fugax in the left eye and transient aphasia. Diffusion-weighted MRI revealed a small infarction in the left insular cortex. Transoral carotid ultrasonography (TOCU)1 demonstrated left ICA dilatation with nar-rowing of the true lumen and intramural mass (figure 1A), which was consistent with hematoma on T1-weighted MRI (figure 1B). Angiography, performed immediately after TOCU, showed luminal carotid stenosis as on TOCU (figure 2) and a diagnosis of ICA dissection was made. Two months later, the TOCU findings were improved (figure e-1 on the Neurology ® Web site at www.neurology.org). TOCU may be useful for noninvasive detection and follow-up of extracranial ICA dissection.2 AUTHOR CONTRIBUTIONS Takayuki Oka contributed to analysis, interpretation of data, and drafting the manuscript. Yusuke Yakushiji contributed to analysis, interpretation of data, and drafting the manuscript. Yusuke Nanri contributed to anal-ysis and interpretation of data. Yukinori Takase contributed to analy-sis and interpretation of data. Hideo Hara contributed to drafting the manuscript. All authors have seen and approved the final version of the manuscript