A previously healthy woman in her 30s presented to the Department of Neurology at First Norman Bethune Hospital of Jilin University with thunderclap neck pain that radiated to the left occiput for 4 days after working for a long time at a computer with lateroversion of the neck. On neurologic examination, there were no other findings but a left Horner syndrome.1 The results from routine hematologic and biochemical tests and computed tomographic brain scan were all normal. The curved planar reformation images from computed tomographic angiography showed tapering stenosis of the left internal carotid artery beginning 2 to 3 cm distal to the bifurcation and extending almost into the skull base (Figure, A). Further investigation of her symptoms was performed to identify the cause of the stenosis.
Zhang F, Liu Y, Xing Y, Yang Y. Diagnosis of Cervical Artery Dissection Using 3-T Magnetic Resonance Imaging. JAMA Neurol. 2015;72(5):600-601. doi:10.1001/jamaneurol.2014.4589