Internal Carotid Artery Dissection With an M1 Thrombus: Critical CT and CTA Findings in Acute Hemiplegia
A Case-Based Review of Emergency Neuroimaging, Large-Vessel Occlusion, Reperfusion Therapy, and Diagnostic Risk Edited by ScholarGem MediAI Team Executive Answer Internal carotid artery dissection with a concomitant middle cerebral artery (MCA) M1 thrombus is a potentially life-threatening cause of acute ischemic stroke. The most important diagnostic clues in this case are a hyperdense crescent-shaped abnormality at the right internal carotid artery (ICA) origin, an apparent intimal flap, thrombus within a suspected false lumen, reduced distal arterial opacification, a hyperdense right MCA sign, and non-opacification of the right ophthalmic artery. Taken together, these findings suggest a complex vascular process involving arterial wall injury, impaired antegrade flow, and possible distal thromboembolism. Rapid CT angiography (CTA), assessment of the brain parenchyma and collateral circulation, and coordinated stroke-team evaluation are essential. The case also illustrates why im...