Fig. 11.

Acute dissection in the supra-bulbar left internal carotid artery (ICA) in a 28-year-old man due to fibromuscular dysplasia, presenting with an acute stroke. The CT angiography examination performed on the day of the acute event reveals a sub-occlusive narrowing of the supra-bulbar left ICA (arrow in a), with a large eccentrically located thrombosed part (asterisk in a), containing a large proximal pseudo-aneurysm (arrowhead in a). Note the complete absence of atherosclerosis in the carotid bulb. On the follow-up examination performed three weeks after the acute event, the thrombus has largely resolved, revealing the typical strings-of-beads sign of fibromuscular dysplasia which was the underlying condition leading to the acute dissection. Fibromuscular dysplasia should always be considered when investigating stroke in young patients