Investigative options include:

Non-contrast CT scan

Because many patients will present with headache and neurological symptoms after a head or neck injury, the initial investigation performed is often a non-contrast CT scan.

This will usually be normal, and this can be falsely reassuring, unless the clinician has a high degree of suspicion for a cervical artery injury.

CT angiograph

CT angiography (CTA) may provide a higher yield for those in whom the clinical suspicion of dissection is high. It may also be useful in trauma patients who are undergoing CT for other indications.

Doppler ultrasound

Doppler ultrasound is fast, convenient and non-invasive and will demonstrate abnormal flow in around 90% of patients with either vertebral or carotid artery dissection. However, it should be noted that it is technically difficult to scan the distal internal carotid. This is therefore a ‘rule-in’ investigation and positive results should be followed up with definitive imaging. The image on the right shows an ultrasound of the carotid artery to detect abnormalities.