J Neurocrit Care.  2022 Jun;15(1):52-56. 10.18700/jnc.210033.

Utility of transoral and transcranial ultrasonography in the diagnosis of internal carotid dissection: a case report

• Cheong I
• Castro VO
• Tamagnone FM

• KMID: 2532000
• DOI: http://doi.org/10.18700/jnc.210033

Abstract

Background
Internal carotid artery (ICA) dissection is one of the most common causes of stroke in young patients. Ultrasonographic assessment of the carotid artery is the method of choice for early detection. The use of the conventional technique for diagnosis is limited since dissection frequently occurs in the distal portion of the ICA.
Case Report
We describe the case of a 48-year-old Argentinian woman with malignant cerebral infarction secondary to ICA dissection. We diagnosed her with neck vessels using conventional ultrasonography and a transoral ultrasonographic approach combined with transcranial ultrasonography.
Conclusion
We recommend the transoral assessment of ICA combined with ultrasonography as a non-invasive method for the diagnosis of ICA dissection.

Keyword

Carotid dissection; Point of care ultrasound; POCUS; Stroke

Figure

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  Fig. 1. Internal carotid artery conventional ultrasonography.

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  Fig. 2. Transoral ultrasonography. Yellow arrow; homogeneous hypoechoic image with absence of Doppler signal compatible with false lumen thrombosis and refinement of the true lumen.

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  Fig. 3. Transoral ultrasonography using pulsed wave Doppler.

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  Fig. 4. Transcranial ultrasonography of the anterior cerebral artery.

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  Fig. 5. Transcranial ultrasonography of the middle cerebral artery.

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  Fig. 6. Transcranial ultrasonography of the distal middle cerebral artery.

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  Fig. 7. Transorbital ultrasonography.

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  Fig. 8. Computed tomography angiography. Yellow arrow: postbulbar region of the left internal carotid artery (ICA) showing progressive reduction of the lumen until it becomes filiform and even undetectable compatible with ICA dissection.

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  Fig. 9. Computed tomography angiography of the intracranial arteries.

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  Fig. 10. Magnetic resonance imaging. Yellow arrow: absence of emptied flow at the level of the petrous and cavernous portion of the left internal carotid artery.

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  Fig. 11. Brain computed tomography of the patient in a coma.

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