Seizure disorder since age 14, recently had an episode in which she had some carpopedal spasm associated with hyperventilation. Evaluation in the emergency room revealed a very high prolactin of 66. She denies any visual field cuts. No causes were identified on physical exam for the hyperprolactinemia.
The right common carotid is visible on the most inferior slices of the scan and is diminutive. The left common carotid is 2 to 3 times the size of the right. The right external carotid artery is patent and normal size however the right internal carotid artery is absent and there is no carotid canal at the skull base suggesting congenital absence. The left internal carotid has a normal course through the carotid canal and cavernous sinus and appears normal at the circle of Willis. There are also large posterior communicating arteries that reconstitute the circle of Willis. The right middle cerebral artery is hypoplastic but opacifies normally. Both anterior cerebral arteries are fed from the left carotid system. Vertebral arteries and basilar artery appear normal.
Another unfortunate young person in a motorcycle collision; my understanding is with a pole.
This injury is rare but there are T-L spine fractures with right costovertebral dislocations. Hematoma surrounds the paraspinal tissues and aorta but no aortic injury.
I think this also has an adventitial bursa. It looks uncomfortable. I can’t remember ever seeing this arrangement of ACL graft fixation before. Especially not one with the threads in the soft tissues.