Abstract
A 48-year-old man experienced sudden onset of blurred vision followed by transient disturbance of speech. No neurological abnormality was observed other than blurry vision. Conventional carotid ultrasonography revealed left internal carotid artery (ICA) occlusion and double lumen was detected by 3D-CTangiography (CTA). A thrombosed pseudolumen was visualized by transoral carotid ultrasonography (TOCU) in the far distal segment of the ICA. We diagnosed ICA dissection and started anticoagulation. However, the patient suffered transient aphasia on Day 3 and acute ischemic lesion in the left insular cortex was revealed on MRI. On Day 16, a blood flow signal was detected on TOCU in the true lumen, but not in the thrombosed pseudolumen. On Day 23, he was discharged from hospital under antiplatelet monotherapy. At the scheduled follow-up with CTA and TOCU on Day 36, asymptomatic arterial dissection was detected in the contralateral right ICA, and was confirmed by conventional angiography. On Day 58, he was discharged without further ischemic events. Symptomatic ICA dissection may be followed by asymptomatic spontaneous contralateral ICA dissection and TOCU offers a powerful tool for detecting this delayed phenomena.
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