Clinical and neuroradiological characteristics of ischemic stroke and subarachnoid hemorrhage in isolated posterior inferior cerebellar artery dissection: Literature review and report of 2 cases

The natural history of spontaneous cerebral artery dissection and thrombosis remains uncertain. Concurrent subarachnoid hemorrhage further complicates the therapeutic approach. Thus the best strategy for managing patients with acute vessel thrombosis in the setting of subarachnoid hemorrhage is unclear. Here we present a case of spontaneous posterior inferior cerebellar artery dissection presenting with subarachnoid hemorrhage and acute thrombosis. Although the patient was initially managed conservatively, angiographic follow-up demonstrated recanalization of the diseased vessel, necessitating definitive treatment. Thus we propose that angiographic follow-up is necessary in the management of patients with subarachnoid hemorrhage in association with apparent vessel thrombosis.

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Isolated Posterior Inferior Cerebellar Artery Dissection as a Cause of Ischemic Stroke: Clinical Features and Prognosis

Cerebrovascular Diseases ◽

10.1159/000439145 ◽

2015 ◽

Vol 40 (5-6) ◽

pp. 215-221 ◽

Cited By ~ 9

Author(s):

Junpei Kobayashi ◽

Tomoyuki Ohara ◽

Masayuki Shiozawa ◽

Kazuo Minematsu ◽

Kazuyuki Nagatsuka ◽

...

Keyword(s):

Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Posterior Inferior Cerebellar Artery ◽

Artery Dissection ◽

Digital Subtraction ◽

Radiological Features ◽

Morphological Evaluation ◽

Cerebellar Artery ◽

Possible Cause

Background: The purpose of this study was to clarify the incidence, clinical and radiological features and outcomes of isolated posterior inferior cerebellar artery (PICA) dissection in isolated PICA territory infarctions. Methods: We retrospectively reviewed consecutive inpatients with ischemic stroke secondary to isolated PICA dissection from our stroke database between January 2004 and December 2013 and reviewed the literature with regard to those patients. Results: Of 167 consecutive patients with an isolated PICA territory infarction, a total of 10 patients (6.0%, 3 women, 48.1 ± 7.1 years) were diagnosed as having an isolated PICA dissection. Patients with PICA dissection were younger (p < 0.001), more commonly experienced headache at onset (p = 0.008), less commonly had hyperlipidemia (p = 0.044) and showed a lower modified Rankin Scale score at discharge (p = 0.002) when compared with patients without arterial dissection. In 6 of these 10 patients, PICA dissections had not been suspected on initial magnetic resonance angiography (MRA) and were confirmed by follow-up MRA or digital subtraction angiography. In the follow-up period (median 1.5 years, interquartile range 0.5-6.3 years), there were no recurrent ischemic or hemorrhagic stroke events. Conclusions: Isolated PICA dissection as an etiological mechanism in isolated PICA territory infarctions may be more common than was previously recognized to be. The diagnosis of PICA dissection is often difficult and requires close and repeated morphological evaluation. We should carefully identify PICA dissections as a possible cause of PICA territory infarctions.

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Subarachnoid hemorrhage then thrombosis of posterior inferior cerebellar artery dissection: is early surgical exploration warranted?

BMJ Case Reports ◽

10.1136/bcr-2015-011740 ◽

2015 ◽

Vol 2015 (may12 1) ◽

pp. bcr2015011740-bcr2015011740

Author(s):

N. G. Alexiades ◽

J. A. Ellis ◽

P. M. Meyers ◽

E. S. Connolly

Keyword(s):

Subarachnoid Hemorrhage ◽

Posterior Inferior Cerebellar Artery ◽

Artery Dissection ◽

Surgical Exploration ◽

Cerebellar Artery

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Diagnosis and follow-up of posterior inferior cerebellar artery dissection complicated with ischemic stroke assisted by T1-VISTA: a report of two cases

BMC Neurology ◽

10.1186/s12883-016-0637-9 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 6

Author(s):

Koji Ishitsuka ◽

Yusuke Sakaki ◽

Shota Sakai ◽

Takeshi Uwatoko ◽

Hitoshi Aibe ◽

...

Keyword(s):

Ischemic Stroke ◽

Posterior Inferior Cerebellar Artery ◽

Artery Dissection ◽

Cerebellar Artery

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Republished: Delayed subarachnoid hemorrhage 7 years after cerebellar infarction from traumatic vertebral artery dissection

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012507.rep ◽

2016 ◽

Vol 9 (4) ◽

pp. e9-e9

Author(s):

Michael A Silva ◽

Alfred P See ◽

Priyank Khandelwal ◽

Nirav J Patel ◽

Mohammad Ali Aziz-Sultan

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Cerebellar Infarction ◽

Radiographic Evidence ◽

Vessel Injury ◽

Cerebellar Artery ◽

The Right

Vertebral artery dissection (VAD) is an important cause of ischemic stroke and subarachnoid hemorrhage (SAH). Dissections presenting with ischemia rarely cause SAH after more than a few hours, especially without radiographic evidence of pseudoaneurysm. We successfully treated a patient for persistent vessel injury presenting with SAH 7 years after presenting with extracranial subocclusive dissection of the right vertebral artery and an associated right posterior inferior cerebellar artery stroke. This is one of only three reported cases of delayed SAH occurring more than 2 weeks after an initial ischemic presentation of a VAD, and the only one without radiographic evidence of pseudoaneurysm at standard follow-up duration.

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