J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):228-232. 10.7461/jcen.2012.14.3.228.

Simultaneous Vertebral Artery Dissection and Contralateral Posterior Inferior Cerebellar Artery Dissecting Aneurysm

• Kwak YS
• Kang DH
• Woo HJ

• KMID: 1808460
• DOI: http://doi.org/10.7461/jcen.2012.14.3.228

Abstract

The optimal treatment and appropriate follow-up period for an unruptured vertebral artery (VA) and/or posterior inferior cerebellar artery (PICA) dissection have not been established. Decisions regarding treatment of these vascular lesions are usually based on the manifesting symptoms and changes in radiologic findings during the follow-up period. We experienced a patient who had a simultaneous unruptured VA dissection and a contralateral PICA dissecting aneurysm. We did not find such a case in other literature.

Keyword

Dissection; Posterior inferior cerebellar artery; Vertebral artery

MeSH Terms

Aneurysm, Dissecting
Arteries
Follow-Up Studies
Humans
Pica
Vertebral Artery
Vertebral Artery Dissection

Figure

• 

  Fig. 1 On source image of time-of-flight (TOF) - magnetic resonance angiography (MRA), high signal intensity (arrow) representing an intramural hematoma is distinguished from flow-related enhancement of the VA (A). The MRA shows a faint signal adjacent to the junction of the right VA and PICA (arrowhead) and a fusiform dilatation of the anterior medullary segment of the left PICA (arrow) (B).

• 

  Fig. 2 A right vertebral angiogram shows the "pearl and string" sign and appearance of a double lumen in the right distal V4 segment of the vertebral artery (VA) involving the origin of the right posterior inferior cerebellar artery (PICA) (A). The follow-up angiograms immediately and three months after stent placement demonstrate good patency of the VA (B, C).

• 

  Fig. 3 A left vertebral angiogram shows focal stenosis with a post-stenotic fusiform aneurysmal dilatation (arrow) of the left proximal posterior inferior cerebellar artery (PICA) suggesting dissection with pseudoaneurysm formation (A). The second angiography at four weeks after symptom onset confirms the reduction of the left PICA dilatation (arrow) (B). Follow-up vertebral arteriography three months later indicates spontaneous resolution of the left PICA dilatation (arrow) (C).

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