Coiled Internal Carotid Arteries Associated with Bilateral Sequential Strokes
Figure 1
((a)–(d)) 39-year-old female presenting with acute onset of a right-sided headache associated with left hemiparesthesia and hemiparesis following sexual intercourse. (a) Initial brain MRI axial DWI sequence demonstrates abnormal restricted diffusion in a watershed distribution of the right cerebral hemisphere consistent with an acute stroke. (b) Axial T1-weighted fat-saturated sequence of the neck vessels demonstrates a hyperintense signal abnormality within the subintimal space of the right internal carotid artery (arrow) consistent with a dissection. (c) Conventional angiogram of the right internal carotid artery demonstrates a 360° loop with an associated fusiform aneurysm filled with thrombus (arrow). (d) Patient presented with acute onset of right hemiplegia and global aphasia 8 years after her first stroke. Brain MRI axial DWI sequence demonstrates a large region of abnormal restricted diffusion in the left cerebral hemisphere consistent with an acute stroke in the left middle cerebral artery distribution. There is encephalomalacia of the right parietal lobe in the region of her prior stroke.
