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. Diffusionweighted MRI revealed a small infarction in the left insular cortex. Transoral carotid ultrasonography (TOCU)1 demonstrated left ICA dilatation with narrowing of the true lumen and intramural mass (figure 1A), which was consistent with hematoma on T1weighted 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