This is a followup of EDNeuroRad Case 41. See the prior case for discussion of additional extensive traumatic findings.

Inferior to the skull base, there is an intimo-medial flap in the right internal carotid artery which extends to the junction of the cervical and petrous segments (@Key Finding 1). There is near occlusion of the vessel prior to skull base entry (@Key Finding 2). Further superiorly, there is an area of what appears to be moderate to severe narrowing of the right ICA in the distal cavernous segment immediately adjacent to the anterior clinoid process, suspicious for an additional site of injury (@Key Finding 3).