On the pre-contrast T1W images of the neck, there is a curvilinear T1 hyperintense lesion seen parallel to the extra-foraminal course of the left vertebral artery at the level of C1-2, measuring 18 x 5mm.
There is moderate mural thickening with eccentric mural enhancement seen on the post-contrast images in this segment of the vertebral artery. This lesion is suggestive of dissection with a hematoma in the false lumen. The true lumen in this segment of the vertebral artery is thinned out, however is still patent.
On the 3D TOF images, the hematoma is seen as bright lesion parallel to the curved course of the left vertebral artery due to the inherent T1 shortening effect seen with subacute hematoma in TOF sequences. This necessitates the use of T1 sequences and Post contrast MRA.
Axial T1C+ fat sat of the skull base revealed left PICA subacute infarct showing enhancement and diffusion restriction on axial DWI.