A 42-year-old man had been in excellent health. He had no vascular risk factors. After strenuous activity (cutting wood) in military service he suddenly felt pain in the right upper jaw which later extended to the ear and the whole right side of his face. He suffered an episode of hazy vision on the right eye lasting about five minutes. The following morning pain had almost disappeared, but he had difficulty swallowing and could not drink properly. His voice had a nasal sound. Otherwise he felt well. In the hospital, three days after first symptoms had occurred, his voice was severely hoarse, almost aphonic, and nasal. On examination he had a drooping right palate arc. On phonation the palate as well as the dorsal wall of the pharynx deviated to the left. Sensation to touch of the right posterior pharyngeal wall was reduced and the gag reflex could not be elicited on the right side. No other signs were found. Chest x-ray, ECG, and routine blood laboratory tests were normal. Initially brainstem infarction was suspected and a posterior fossa CT scan was performed which was normal. Because of the right sided facial pain and the initial episode of presumed right amaurosis fugax, right ICA dissection was suspected.Duplex sonographic examination of the carotid arteries performed the same day showed a patent carotid bifurcation, no atherosclerotic changes, and symmetrical blood flow velocities. Both common carotid arteries were also normal. Pulsed Doppler sonographic examination of the upper cervical segments of both ICAs disclosed a coiling of both with adjacent antegrade and retrograde flow in the high cervical portion. However, the blood flow velocities on the right side were twice as high as on the left side in both flow directions. This finding supported the diagnosis of an ICA dissection and anticoagu-

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There is controversy about how extensive lymph node dissection (LND) should be during prostatectomy. We investigated the lymphatic drainage of the prostate and whether sentinel node fluorescence techniques would be useful to detect node metastases. We found that the drainage pattern is complex and that the sentinel node technique is not able to replace extended pelvic LND.

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