J Korean Neurosurg Soc.  2012 Mar;51(3):160-163. 10.3340/jkns.2012.51.3.160.

A Case of Lateral Medullary Infarction after Endovascular Trapping of the Vertebral Artery Dissecting Aneurysm

• Cho IY
• Hwang SK

• KMID: 2018191
• DOI: http://doi.org/10.3340/jkns.2012.51.3.160

Abstract

We report an unusual case of lateral medullary infarction after successful embolization of the vertebral artery dissecting aneurysm (VADA). A 49-year-old man who had no noteworthy previous medical history was admitted to our hospital with a severe headache. Computed tomography (CT) revealed a subarachnoid hemorrhage, located in the basal cistern and posterior fossa. Cerebral angiography showed a VADA, that did not involve the origin of the posterior inferior cerebellar artery (PICA). We treated this aneurysm via endovascular trapping of the vertebral artery distal to the PICA. After operation, CT revealed post-hemorrhagic hydrocephalus, which we resolved with a permanent ventriculoperitoneal shunt procedure. Postoperatively, the patient experienced transient mild hoarsness and dysphagia. Magnetic resonance image (MRI) showed a small infarction in the right side of the medulla. The patient recovered well, though he still had some residual symptom of dysphagia at discharge. Such an event is uncommon but can be a major clinical concern. Further investigation to reveal risk factors and/or causative mechanisms for the medullary infarction after successful endovascular trapping of the VADA are sorely needed, to minimize such a complication.

Keyword

Vertebral artery; Dissection; Lateral medullary infarction

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Arteries
Cerebral Angiography
Deglutition Disorders
Headache
Humans
Hydrocephalus
Infarction
Magnetic Resonance Spectroscopy
Middle Aged
Pica
Risk Factors
Subarachnoid Hemorrhage
Ventriculoperitoneal Shunt
Vertebral Artery

Figure

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  Fig. 1 A : Computed tomography axial image demonstrating a diffuse subarachnoid hemorrhage in the basal cistern. B : Preoperative right vertebral angiography showing a typical dissecting aneurysm of the vertebral artery distal to the posterior inferior cerebellar artery.

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  Fig. 2 Postembolization right vertebral angiography, anteroposterior (A) and lateral (B) view, demonstrating complete occlusion of the right vertebral artery and good patency of the right posteroinferior cerebellar artery. Postembolization left vertebral angiography (C) demonstrating supply of lower part of the basilar artery and the left posterior inferior cerebellar artery and the absence of retrograde filling of the dissecting aneurysm. Left internal carotid angiography (D) showing a good blood flow of the basilar and the left posterior cerebral artery through collateral flow from the posterior communicating artery.

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  Fig. 3 Postembolization magnetic resonance T2-weighted image showing a low signal area in the ventral aspect of the right medulla oblongata.

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