Neuroimaging: carotid artery dissection: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: carotid artery dissection

Sample item

A 35-year-old develops a painful left Horner syndrome and a right hemiparesis after neck manipulation. Fat-suppressed T1 MRI of the neck shows a crescent of high signal around a narrowed left internal carotid lumen. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Carotid artery dissection

An intramural haematoma in a dissected carotid appears as a crescent of T1 hyperintensity on fat-suppressed images. Pain with Horner syndrome and cerebral ischaemia after trauma or manipulation is the typical presentation.

Option by option

  • A. Carotid artery dissection (correct)

    Correct. A fat-suppressed T1 crescent around a narrowed lumen is the signature of dissection.

  • B. Fibromuscular dysplasia

    Fibromuscular dysplasia gives a string-of-beads appearance on angiography, without a wall haematoma.

  • C. Cardioembolic occlusion

    Cardioembolic occlusion shows an abrupt cut-off with no wall haematoma.

  • D. Takayasu arteritis

    Takayasu arteritis causes long segment concentric wall thickening in young women, usually with systemic features.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Carotid artery dissection. An intramural haematoma in a dissected carotid appears as a crescent of T1 hyperintensity on fat-suppressed images.

Why is "Fibromuscular dysplasia" not the answer?

Fibromuscular dysplasia gives a string-of-beads appearance on angiography, without a wall haematoma.

Why is "Cardioembolic occlusion" not the answer?

Cardioembolic occlusion shows an abrupt cut-off with no wall haematoma.

Why is "Takayasu arteritis" not the answer?

Takayasu arteritis causes long segment concentric wall thickening in young women, usually with systemic features.

What concept does this question test?

It tests Neuroimaging: carotid artery dissection in Radiology. Pain with Horner syndrome and cerebral ischaemia after trauma or manipulation is the typical presentation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: carotid artery dissection?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.