case_images: PMC3502825_01
case_images: In native scan and with duplex mode, an irregular membrane crossing the vessel with a true and a false lumen was observed.
case_images: CRIM.VASMED2012-254204.001.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.001.jpg
case_images: fig1
case_images: Although the acute incident happened 5 months ago, in carotid artery duplex scanning, an irregular membrane crossing the vessel with a true and a false lumen was still observed (Figure 1).
case_images: High-grade stenosis of the right common carotid artery (CCA).
case_images: CRIM.VASMED2012-254204.002.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.002.jpg
case_images: fig2
case_images: Moreover, a high-grade stenosis of the right common carotid artery with a peak systolic velocity (PSV) of up to 362 cm/sec was revealed (Figure 2).
case_images: Considerably reduced PSV in the right ICA (automatic detection shows a normal PSV due to the measurement of poststenotic turbulences).
case_images: CRIM.VASMED2012-254204.003.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.003.jpg
case_images: fig3
case_images: Furthermore, the PSV was considerably reduced in the right ICA as a clear sign of haemodynamic significance (Figure 3).
case_images: Hypoperfusion in brain area corresponding to the right MCA.
case_images: CRIM.VASMED2012-254204.004.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.004.jpg
case_images: fig4
case_images: MR imaging demonstrated hypoperfusion in brain area corresponding to the right MCA (Figure 4) as a sign of haemodynamic impairment in impending watershed infarction.
case_images: Obvious low flow in right distal ICA.
case_images: CRIM.VASMED2012-254204.005.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.005.jpg
case_images: fig5
case_images: Right distal ICA was clearly less contrasted in MR angiography as an indirect sign of the upstream stenosis of right CCA (Figure 5).
case_images: Reduced flow in the right MCA with a cross flow from the left hemisphere.
case_images: CRIM.VASMED2012-254204.006.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.006.jpg
case_images: fig6
case_images: Finally, the intracranial MR angiography revealed an insufficient cross flow from the left to the right side via the anterior circulation and via ramus communicans posterior resulting in a reduced flow in the right MCA (Figure 6).
case_images: Known dissection Stanford type A with transmitted dissection membrane in brachiocephalic artery, subclavian artery on both sides, and left CCA.
case_images: CRIM.VASMED2012-254204.007.jpg
case_images: PMC3502825_01_CRIM.VASMED2012-254204.007.jpg
case_images: fig7