There have been only two nonstroke iPICAD cases reported, and one of these was diagnosed with coexisting VAD. In the last decade, over 70 cases of iPICAD have been found in the literature, but almost all the cases included subarachnoid hemorrhages or infarctions. The reports of iPICAD with stroke are increasing with the advancement of high-resolution MRI techniques, but those without stroke are still limited. Īmong cervicocephalic artery dissections, vertebral artery dissections (VADs) are common, and the therapeutic strategy for VAD has been established. The outer diameter was followed by basi-parallel anatomical scanning (BPAS), one type of T2-weighted HRVWI. T1-weighted HRVWI was used to confirm the intraluminal size change. The patient has resumed activities, such as marathon racing, again.Ĭonventional angiography may have provided useful information to confirm the patient’s PICA condition however, for this patient, serial high-resolution MRI examinations, including HRVWI, were sufficient to confirm the condition of the vessel. Finally, four months after the onset, the outer diameter was observed to be almost normal in size and shape (Fig. Eight weeks after the onset, his PICA looked almost normal on MIP and T1-weighted HRVWI, though the outer diameter was still bulging on a T2-weighted HRVWI (BPAS). Four weeks after the onset, the dissection finding on MIP images began to improve. At that time, surgical or endovascular treatment to prevent subarachnoid hemorrhage was recommended however, the patient, who had been relieved of severe headache, desired to continue conservative therapy. 2a), though the patient’s headache improved markedly on the eighth day (Fig. Two weeks after the onset of headache, the diameter of the dissected vessel grew to the maximum size (Fig. The severity of the headache was assessed by Numerical Rating Scale (NRS) every day. 1f) and T2-weighted HRVWI (basi-parallel anatomical scanning (BPAS) Fig. The inner and outer diameters of the dissected PICA were measured by MRI T1-weighted high-resolution vessel wall imaging (HRVWI) (Fig. Conventional angiography was not performed because the PICA could be observed by serial high-resolution MRI examinations and angiography was not considered necessary in this case. The other MRI sequences showed no infarctions or hemorrhages (Fig. MRA on the seventh day revealed that there was an association between the change in shape and volume of the PICA and the time elapsed, strongly suggesting PICAD (Fig. No intramural hematoma, double lumen finding or intimal flap were observed, but PICA dissection (PICAD) could not be ruled out, and the patient was therefore carefully observed, with continuous monitoring of blood pressure, heart rate and other vital signs also, he was hydrated sufficiently and given analgesic anti-inflammatory agents. MRI examinations showed a tiny dissection-like finding (pearl and string sign-like) on his right proximal segment (tonsillomedullar segment) of posterior inferior cerebellar artery (PICA) (Fig. This is the first detailed report on a nonstroke isolated posterior inferior cerebellar artery dissection that spontaneously occurred and healed, observed by serial high-resolution MRI examinations.Ī 48-year-old male, who had no past medical or traumatic history and no family history of cerebral artery dissections, suddenly felt a severe, throbbing headache on the right side and came to our clinic on the fourth day following onset. Four months later, MRI examinations showed his right posterior inferior cerebellar artery was almost normal in size and shape. Gradually, the dissection finding improved. Surgical or endovascular treatments for prevention of subarachnoid hemorrhage were recommended, but careful conservative therapy was continued in accordance with the patient’s wishes. Two weeks later, the dissected vessel’s diameter grew to the maximum size, though the patient’s headache rapidly improved around that day. He was observed carefully with continuous monitoring of blood pressure, hydrated sufficiently, and given analgesic anti-inflammatory agents. MRI examinations revealed a right posterior inferior cerebellar artery dissection and showed no infarctions or hemorrhages. Case presentationĪ 48-year-old healthy male felt a severe, throbbing headache on the right side and came to our clinic on the fourth day following onset. Surgical and endovascular treatments for hemorrhagic stroke cases and medical treatments using antithrombotic agents for ischemic stroke cases have been performed, but there are very few reports on nonstroke isolated posterior inferior cerebellar artery dissections, and the treatment strategy for nonstroke cases has not been established. Isolated posterior inferior cerebellar artery dissections can cause subarachnoid hemorrhages or infarctions.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |