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Internal carotid artery and vertebral artery dissections following left middle cerebral artery infarction

This patient is a 35-year-old man with left middle cerebral artery infarction 2 days after lifting heavy objects. Dissections are of both internal carotid arteries/both vertebral arteries by angiography. (A) Left common carotid artery (CCA) injection, lateral view. Dorsal cervical left internal carotid artery (ICA) pseudoaneurysm and long-segment dissection of the cervical/vertical petrous left ICA. (B) Right CCA injection, AP view. Pseudoaneurysm of the distal cervical/vertical petrous right ICA with filling defect/intraluminal thrombus. (C) Left vertebral artery injection, lateral view. Long-segment dissection of the cervical left vertebral artery with pseudoaneurysm at C3. (D) Right subclavian artery injection, AP view. Dissection with intimal flap of the medial wall of the proximal cervical right vertebral artery. (Contributed by Dr. Jose Biller.)