Introduction Sequelae of dissection leading to a form of stenotic aneurysmal dilatation may predispose to thromboembolic stroke, and characteristic imaging findings in the setting of stroke should prompt consideration of this diagnosis.

Case Description A 48-year-old woman, an active smoker and left-handed, presented with symptoms over a 3-week period, including initial weakness of the left lower limb followed by weakness of the left upper limb and aphasia, consistent with transient ischemic attacks affecting the territory of the right middle cerebral artery (MCA).

MRI revealed a stroke in the right MCA territory associated with a tight stenosis of the supra-bulbar right internal carotid artery, accompanied by an irregular aneurysmal sac immediately downstream. The aneurysmal sac displayed irregularity and exhibited slight T1 hyperintensity at its apex, prompting consideration of partial thrombosis. Anticoagulation therapy was initiated, and a follow-up MRI and CT scan after 3 days showed enlargement of the aneurysmal sac attributed to thrombus regression at its base.

Results To prevent recurrence, exclusion of the aneurysmal sac via carotid stenting was performed.

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Abstract P073 Figure 1

Disclosure of Interest no.