Dissection extending from extra- to intracranial arteries

RATIONALE Cervicocephalic artery dissections, once considered a rare disease, have become increasingly recognized as a cause of stroke in young and middle-aged individuals. Early diagnosis is mandatory because anticoagulation or antithrombotic therapy can help prevent primary or secondary ischemic events. However, the diagnosis is still a crucial challenge for radiologists and neurologists. PATIENT CONCERNS We reported a rare case of 33-year-old patient with progressive ischemic stroke due to dissection from an intimal tear in the right proximal internal carotid artery to distal middle cerebral artery. DIAGNOSES 3D fat-saturated T1 VISTA imaging, owing to its comprehensive neck and head coverage, high spatial resolution, enables the reader to have several sections with good contrast covering the dissected arterial segment, even in the rare dissection involving extra- and intra-cranial arteries referred in this article. INTERVENTIONS Clopidogrel 75mg daily was prescribed, also the patient was given rehabilitation training. OUTCOMES His symptoms improved gradually. LESSONS We describe that 3D fat-saturated T1 VISTA was helpful for the diagnosis and follow-up in our case of cervicocephalic artery dissection complicated with progressive ischemic stroke. However, for totally acute occlusion of the artery without typical features of dissection, the unequivocal distinction between intramural haematoma and intraluminal thrombus may still be difficult with 3D fat-saturated T1 VISTA alone. Future studies should investigate whether an optimal VISTA technique would be useful for making a definite diagnosis.