Craniocervical arterial dissections with cerebral infarction: a five-case series with diagnostic application of vessel wall MRI.

Craniocervical arterial dissection (CCAD) is an important but often underdiagnosed cause of ischemic stroke, especially in young and middle-aged adults. We present a series of 5 patients (three men and 2 women, aged 25-45 years) with acute ischemic stroke secondary to CCAD, including 2 internal carotid artery dissections and 3 vertebral artery dissections. Initial computed tomography (CT) and CT angiography were inconclusive, while high-resolution vessel wall MRI (VW-MRI) revealed characteristic features such as intramural hematoma, intimal flap, double lumen, and mural enhancement. All patients were treated with aspirin monotherapy and demonstrated favorable outcomes without recurrence during short-term follow-up. This series highlights the diagnostic value of VW-MRI in patients with cryptogenic stroke and inconclusive CTA, underscoring its role in timely diagnosis and management of CCAD.