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

2015 ◽  
Vol 40 (5-6) ◽  
pp. 215-221 ◽  
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.

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

2015 ◽  
Vol 8 (6) ◽  
pp. e22-e22
Author(s):  
Nikita G Alexiades ◽  
Jason A Ellis ◽  
Philip M Meyers ◽  
E Sander Connolly
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Definitive Treatment ◽  
Artery Dissection ◽  
Acute Thrombosis ◽  
Cerebellar Artery ◽  
History Of ◽  
Diseased Vessel ◽  
Vessel Thrombosis

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.

scholarly journals Spontaneous Vertebral Artery Dissection Presenting with Crescendo TIAs and Headache

2019 ◽  
pp. 1-6
Author(s):  
Dr. Nosakhare I Idehen ◽  
Dr. Mohammed Awad
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Symptomatic Improvement ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Neurological Sequelae ◽  
Cerebellar Artery ◽  
Ct Brain

We present the case of a man in his thirties who had attended the emergency department with complaint of a distressing headache and associated intermittent facial droop with occasional slurred speech. The patient’s symptoms were bizarre in their nature as they were random, not sustained and he had long intervals when he was asymptomatic and was his normal self. During the course of admission his symptoms evolved resulting in neurological deficits which were more sustained, prompting the need for further imaging beyond the initial plain CT brain which showed no abnormality. This led to the diagnosis of vertebral artery dissection (VAD) complicated with an ischaemic stroke in the posterior inferior cerebellar artery distribution (PICA) on MRI/MRA. Dual anti-platelet treatment was commenced with the patient attaining gradual symptomatic improvement prior to discharge. He has reported some degree of neurological sequelae which he described as intermittent poor coordination on follow up visit in clinic after discharge.

Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms

2016 ◽  
Vol 9 (12) ◽  
pp. 1233-1237 ◽  
Author(s):  
Katharina Melber ◽  
Dan Meila ◽  
Philipp Draheim ◽  
Dominik Grieb ◽  
Björn Greling ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Posterior Inferior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Digital Subtraction ◽  
Stent Deployment ◽  
Closed Cell ◽  
Cerebellar Artery ◽  
Before And After

IntroductionSingle stent deployment leads to a change in vascular geometry in wide necked bifurcation aneurysms. In some complex cases, the use of the single stent technique might not be sufficient or may not be feasible. The kissing-Y stenting technique appears to be an alternative endovascular treatment option. The aim of this study was to evaluate the effects of the kissing-Y stenting technique on vascular angular remodeling.Methods21 patients with wide necked intracranial bifurcation aneurysms at different sites (10 anterior communicating artery, 6 middle cerebral artery, 3 basilar artery, 1 vertebral artery/posterior inferior cerebellar artery, 1 internal carotid artery/posterior communicating artery) were treated with 44 closed cell stents (follow-up 2012–2016) using the kissing-Y stenting technique. We analyzed vascular angle geometry between the mother and both affected daughter vessels by digital subtraction angiography, before and after stent deployment, using standard working projections.ResultsEndovascular treatment of wide necked intracranial aneurysms using the kissing-Y stenting technique significantly decreased the angle between the bifurcation branches from 130.4±9.5° to 91.5±9.1° (p<0.0001).ConclusionsKissing-Y stenting in wide necked bifurcation aneurysms leads to vascular angular remodeling of both affected branches. The resulting straightening of the bifurcation angle may prevent aneurysmal recurrence.

Abstract TP213: Initial Vascular Lesion Patterns on Early Images Would Predict Vascular Outcomes in Acute Cerebral Artery Dissection

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jun Lee ◽  
Jungim Gwon ◽  
Mingyeong Kim
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Vascular Lesion ◽  
Vascular Imaging ◽  
Vascular Lesions ◽  
Artery Dissection ◽  
Imaging Features ◽  
Imaging Characteristics ◽  
Cerebellar Artery ◽  
Cervicocerebral Artery Dissection

Introduction: Imaging characteristics and prognosis on the follow-up imaging in patients with acute cervicocerebral artery dissection are not well established. Hypothesis: Initial lesion patterns on early vascular imaging would predict vascular imaging outcomes in acute cervicocerebral artery dissection. Methods: Individual clinical data and imaging features were obtained from 167 consecutive patients who presented with acute ischemic symptoms or headache due to cervicocerebral artery dissection. Patients were categorized according to their baseline vascular imaging features as either Stenosis Only, Aneurysm Only, or Both Stenosis and Aneurysm. The angiographic characteristics and improvements of early vascular lesions between baseline (within 7 days after symptoms onset) and follow-up vascular images (6-month or 1-year after symptom onset) were compared. Results: A total of 76 patients who underwent baseline and 6-month or 1-year vascular imaging were included. Patients in the Stenosis Only group (n=36) were younger (mean age, 45±11) than those in the Aneurysm Only (n=9, 55±7) and Both Stenosis and Aneurysm (n=31, 48±12) groups (p=0.044). The most common sites of lesions were the distal vertebral artery and posterior inferior cerebellar artery (n=43, 57%). All patients in Aneurysm Only group had their lesions in the posterior circulation (61% in Stenosis Only, 77% in Both Stenosis and Aneurysm; p=0.047). A total of 43 patients (57%) showed improvement of initial lesions on follow-up vascular images (58% in Stenosis Only vs. 22% in Aneurysm Only vs. 65% in Both Stenosis and Aneurysm; p=0.076). The proportion of patients who obtained improvements on follow-up vascular images on baseline images was lower in Aneurysm Only compared with groups with stenosis (Stenosis Only and Both Stenosis and Aneurysm) (Odds ratio 0.18, 95% CI 0.03 to 0.94; p=0.035). Conclusions: Complete or partial improvements on follow-up images are obtained in over half of the patients with acute cervicocerebral artery dissection. Patients with only aneurysm on early images showed poor imaging prognosis compared to patients with stenosis.

Hemifacial Spasm: Endoscopic Vascular Decompression

1997 ◽  
Vol 117 (4) ◽  
pp. 308-314 ◽  
Author(s):  
J. Magnan ◽  
F. Caces ◽  
P. Locatelli ◽  
A. Chays
Keyword(s):  
Hemifacial Spasm ◽  
Marked Improvement ◽  
Cerebellopontine Angle ◽  
Posterior Inferior Cerebellar Artery ◽  
Endoscopic Examination ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
The Mean ◽  
Vascular Decompression

Sixty patients with primitive hemifacial spasm were treated by means of a minimally invasive retrosigmoid approach in which endoscopic and microsurgical procedures were combined. Intraoperative endoscopic examination of the cerebellopontine angle showed that for 56 of the patients vessel-nerve conflict was the cause of hemifacial spasm. The most common offending vessel was the posterior inferior cerebellar artery (39 patients), next was the vertebral artery (23 patients), and last was the anterior inferior cerebellar artery (16 patients). Nineteen of the patients had multiple offending vascular loops. In one patient, another cause of hemifacial spasm was an epidermoid tumor of the cerebellopontine angle. For three patients, it was not possible to determine the exact cause of the facial disorder. Follow-up information was reviewed for 54 of 60 patients; the mean follow-up period was 14 months. Fifty of the patients were in the vessel-nerve conflict group. Forty of the 50 were free of symptoms, and four had marked improvement. The overall success rate was 88%, and there was minimal morbidity (no facial palsy, two cases of severe hearing loss).

scholarly journals Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms

2017 ◽  
Vol 126 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Jun Wang ◽  
Xin-Feng Liu ◽  
Bao-Min Li ◽  
Sheng Li ◽  
Xiang-Yu Cao ◽  
...  
Keyword(s):  
Stent Placement ◽  
Late Onset ◽  
Posterior Inferior Cerebellar Artery ◽  
Small Subset ◽  
Acceptable Result ◽  
Basilar Artery Thrombosis ◽  
Artery Thrombosis ◽  
Cerebellar Artery ◽  
Placement Technique

OBJECTIVE Large vertebrobasilar fusiform aneurysms (VFAs) represent a small subset of intracranial aneurysms and are often among the most difficult to treat. Current surgical and endovascular techniques fail to achieve a complete or acceptable result because of complications, including late-onset basilar artery thrombosis and perforator infarction. The parallel-stent placement technique was established in the authors' department, and this study reports the application of this technique in the treatment of unruptured VFAs. METHODS Eight patients with 8 unruptured VFAs who underwent parallel stent placement between April 2011 and August 2012 were included. The diameters of the VFAs ranged from 7.9 to 14.0 mm, and the lengths from 27.5 to 54.4 mm. Of the 8 patients with unruptured VFAs, 3 received double or triple parallel stents and 5 patients received a series-connected stent with another 1 or 2 stents deployed parallel to them. Outcomes for these patients were tabulated, based on the modified Rankin Scale (mRS) score and angiographic results. RESULTS All of the 25 stents were successfully placed without any treatment-related complications. During follow-up, 5 patients had decreased mRS scores, 2 were unchanged, and 1 was increased for subarachnoid hemorrhage. Immediate and follow-up clinical outcome was completely or partially recovered in most patients. Follow-up angiograms revealed 2 aneurysms were reduced in size and 6 were unchanged after stent placement. No in-stent stenosis, occlusion of the posterior inferior cerebellar artery, or perforators jailed by the stent occurred in any of the aneurysms. CONCLUSIONS These results provide encouraging support for the parallel-stent placement technique, which can be envisaged as an alternative strategy against unruptured VFAs. However, testing in more patients is needed.

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