scholarly journals Clinical and Radiological Profile of Patients Presenting With Isolated Acute Cerebellar Infarct: A Single Tertiary Center 3 Years Retrospective Study From Central Stroke Unit, Muscat, Oman

2021 ◽  
pp. 251660852110382
Author(s):  
Amal M. Al Hashmi ◽  
Sanjith Aaron ◽  
Ahmed Al Sinani ◽  
Divyan Pancharatnam
Keyword(s):  
Retrospective Study ◽  
Stroke Unit ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Large Artery ◽  
Presenting Symptoms ◽  
Cerebellar Artery ◽  
Tertiary Center ◽  
Cerebellar Infarct ◽  
Prompt Diagnosis

Introduction: Cerebellar infarct can present with a broad spectrum of clinical and radiographic features. Recognizing this spectrum is extremely important for prompt diagnosis and to avoid morbidity and mortality. Objective: To identify the clinical and radiological profile of patients presenting with isolated acute cerebellar infarct. Methods: Retrospective study carried out at the central stroke unit of Oman over 27 months. Only patients with isolated acute cerebellar infarct confirmed by either magnetic resonance imaging or computerized tomography (CT) were included in this study. A total of 76 cases were identified. Results: Isolated cerebellar infarct constituted 4% of all acute ischemic strokes treated during the study period. Gait imbalance and difficulty in articulating were seen in 30/48 (63%) and 12/48 patients (25%), respectively. Ataxia and nystagmus were the main signs seen 30/48 (63%) and 10/48 (21%), respectively. Large artery atherosclerosis comprised 15/48 (31%), of the underlying etiology. Normal and complete posterior circulation was seen only in 6/36 (17%). Unilateral or bilateral hypoplasia or absence of posterior communicating artery (PCOM) were the commonest variants seen in our patients. The cerebellar arterial territory most commonly involved in this series was posterior inferior cerebellar artery (58%). Infarct extension was seen in 10/48 patients (21%), with 4/10 (40%) having bilateral absent PCOM followed by 2/10 (20%) normal posterior circulation. Conclusions: Acute gait imbalance and difficulty in articulating can be the only presenting symptoms in isolated cerebellar infarct. Plain CT in the acute phase can miss such infarcts in up to 46% cases. The majority of cases had an incomplete anatomy of the posterior circulation.

Multidisciplinary Treatments of True Posterior Inferior Cerebellar Artery Aneurysms: Single-Center Retrospective Study and Treatment Algorithm

2020 ◽  
Vol 139 ◽  
pp. e45-e51
Author(s):  
Yukihide Kanemoto ◽  
Yuhei Michiwaki ◽  
Kazushi Maeda ◽  
Yosuke Kawano ◽  
Naoki Maehara ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Posterior Inferior Cerebellar Artery ◽  
Treatment Algorithm ◽  
Single Center ◽  
Cerebellar Artery

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

Embolization of Posterior Circulation Aneurysms with Detachable Coils

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 127-130 ◽  
Author(s):  
K. Kazekawa ◽  
T. Fukushima ◽  
M. Tomonaga ◽  
T. Kawano ◽  
T. Kawaguchi ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Vertebrobasilar Junction

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs. In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery. Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.

Skull base approaches to the basilar artery

2005 ◽  
Vol 19 (2) ◽  
pp. 1-12 ◽  
Author(s):  
L. Fernando Gonzalez ◽  
Sepideh Amin-Hanjani ◽  
Nicholas C. Bambakidis ◽  
Robert F. Spetzler
Keyword(s):  
Skull Base ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Free Edge ◽  
Posterior Circulation ◽  
Surgical Instruments ◽  
Petrous Apex ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery

Posterior circulation lesions constitute approximately 10% of all intracranial aneurysms. Their distribution includes the basilar artery (BA) bifurcation, superior cerebellar artery, posterior inferior cerebellar artery, and anterior inferior cerebellar artery. The specific features of a patient's aneurysm and superb anatomical knowledge help the surgeon to choose the most appropriate approach and to tailor it to the patient's situation. The main principle that must be applied is maximization of bone resection. This allows the surgeon to work within a wider corridor, which facilitates the use of surgical instruments and minimizes retraction of the brain. The management of aneurysms within the posterior circulation requires expertise in skull base and vascular surgery. Endovascular treatments have become increasingly important, but in this paper the authors focus on the surgical management of these difficult aneurysms. The paper is divided into three parts: the first section is a brief review of the anatomy of the BA; the second part is a review of the techniques associated with the management of posterior fossa aneurysms; and in the third section the authors describe the different approaches, their nuances and indications based on the location of the aneurysm, and its relationship to the surrounding bone (especially the clivus, dorsum sellae, and the free edge of the petrous apex).

Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels

2015 ◽  
Vol 8 (10) ◽  
pp. 1041-1047 ◽  
Author(s):  
Marcus D Mazur ◽  
Craig Kilburg ◽  
Victor Wang ◽  
Philipp Taussky
Keyword(s):  
Vertebral Artery ◽  
Vessel Wall ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Cerebellar Artery ◽  
Flow Through ◽  
Flow Diverting Stent

IntroductionPreliminary studies suggest that flow-diverting stents may be suitable for the treatment of aneurysms of the posterior circulation. The safety and efficacy of using flow-diverting stents for vertebral artery (VA) aneurysms is not well defined.ObjectiveTo examine the fate of covering the posterior inferior cerebellar artery (PICA) in patients undergoing placement of a flow-diverting stent for VA aneurysm.MethodsConsecutive patients who underwent placement of a Pipeline Embolization Device (PED) for treatment of an aneurysm of the V4 segment of the VA between April 2012 and June 2015 at our institution were retrospectively evaluated. Angiograms were reviewed to determine the patency of the PICA when the vessel origin was covered by the PED.Results11 patients with VA aneurysms who underwent treatment with the PED were identified. In each case the device covered the origin of the PICA. Follow-up angiography in eight patients demonstrated thrombosis of the aneurysm with patency of the PICA.ConclusionsFlow-diverting stents can be used for the treatment of VA aneurysms. When appropriately sized to the vessel wall and positioned in the VA, the device may cover the origin of the PICA without impairing flow through the branching artery.

scholarly journals STROKE ISKEMIK DENGAN MANIFESTASI DIZZINESS/VERTIGO TERISOLASI

2020 ◽  
Vol 37 (2) ◽  
Author(s):  
Diyan Anita Sari ◽  
Sri Sutarni ◽  
Ismail Setyopranoto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Diffusion Weighted Imaging ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Resonance Imaging ◽  
Acute Vestibular Syndrome ◽  
Cerebellar Artery ◽  
Magnetic Resonance Imaging Mri

ISCHEMIC STROKE PRESENTS WITH ISOLATED DIZZINESS/VERTIGOABSTRACTDizziness/vertigo, unstable walking or loss of balance are symptoms in about 50% of stroke cases. However, only about 20% are accompanied by focal neurological signs. In the last decade, there is increasing evidence that vertigo can be the only ischemic symptom of posterior circulation stroke without a focal sign. The purpose of this systematic review is to examine the literature on ischemic stroke with the manifestation of isolated dizziness/vertigo. The literature search is done through several electronic database (Pubmed, Ebscohost, and Proquest) from 2000 to 2017 using keywords; isolated vertigo, isolated dizziness, ischemic stroke, vertebrobasilar, posterior stroke, magnetic resonance imaging (MRI). Six articles were obtained that meet the criteria. Approximately 9-10% of patients with isolated dizziness/vertigo who had a history of vascular risk factors, found to have infarct lesions from MRI diffusion weighted  imaging (DWI) examination. In this case, the territory of posterior inferior cerebellar artery (PICA) is most often involved. Acute ischemic stroke can not be excluded only on the basis of negative DWI examination results. Head impulse, nystagmus, and test of skew (HINTS) plus examination may identify acute vestibular syndrome with a central cause with better accuracy than MRI DWI at the onset of symptom.Keywords: Acute vestibular syndrome, ischemic stroke, isolated dizziness, isolated vertigo, posterior circulation strokeABSTRAKDizziness/vertigo, berjalan tidak stabil atau kehilangan keseimbangan merupakan gejala pada sekitar 50% kasus stroke. Namun, hanya sekitar 20% disertai tanda neurologis fokal. Pada dekade terakhir, semakin banyak bukti bahwa vertigo dapat sebagai satu-satunya gejala iskemik sirkulasi posterior tanpa tanda fokal. Tujuan penulisan tinjauan sistematik ini adalah untuk mengkaji literatur tentang stroke iskemik dengan manifestasi hanya dizziness/vertigo terisolasi. Pencarian literatur dilakukan melalui database elektronik (Pubmed, Ebscohost, dan Proquest) dari tahun 2000 hingga 2017 dengan kata kunci; isolated vertigo, isolated dizziness, ischemic stroke, vertebrobasilar, posterior stroke, magnetic resonance imaging (MRI). Didapatkan 6 artikel yang memenuhi kriteria. Sebanyak 9-10% dari pasien dengan dizziness/vertigo terisolasi yang memiliki riwayat faktor risiko vaskular, ditemukan lesi infark dari pemeriksaan MRI diffusion weighted  imaging (DWI). Dalam hal ini, teritori posterior inferior cerebellar artery (PICA) yang paling sering terlibat. Stroke iskemik akut tidak dapat disingkirkan hanya berdasar hasil pemeriksaan DWI negatif. Pemeriksaan head impulse, nystagmus, and test of skew (HINTS) plus dapat mengidentifikasi sindrom vestibular akut dengan penyebab sentral dengan akurasi yang lebih baik dibanding MRI DWI di awal onset gejala.Kata kunci: Dizziness terisolasi, sindrom vestibular akut, stroke iskemik, stroke sirkulasi posterior, vertigo terisolasi

Acute Treatment of Ruptured Fusiform Posterior Circulation Posterior Cerebral, Superior Cerebellar, and Posterior Inferior Cerebellar Artery Aneurysms With FRED Flow Diverter: Report of 5 Cases

2018 ◽  
Vol 16 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Dan Laukka ◽  
Riitta Rautio ◽  
Melissa Rahi ◽  
Jaakko Rinne
Keyword(s):  
Treatment Time ◽  
Brain Infarction ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
External Ventricular Drainage ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Technical Success Rate ◽  
Cerebellar Artery

Abstract BACKGROUND Flow diverter (FD) treatment of ruptured fusiform posterior cerebral artery (PCA), posterior inferior cerebellar artery (PICA), and superior cerebellar artery (SCA) aneurysms are limited to single reports. OBJECTIVE To study the safety and efficacy of FD treatment for ruptured fusiform aneurysms of the PCA, SCA, and PICA. METHODS Five patients with ruptured posterior circulation fusiform aneurysms and treated with a Flow-Redirection Endoluminal Device (FRED/FRED Jr; Microvention, Tustin, California) stent in the acute phase of subarachnoid hemorrhage between 2013 and 2016 were included and reviewed retrospectively. RESULTS Two aneurysms located on the PICA, 2 on PCA, and 1 on the SCA. Mean treatment time with FD was 5.8 d (range, 0-11 d) from ictus. The technical success rate was 100%. On admission 2 patients were Hunt and Hess grade 1, 2 patients grade 3, and 1 patient grade 4. At discharge, 4 patients (80%) were independent (modified Ranking Scale (mRS) ≤2) and 1 patient had severe disability (mRS 4). None of the patients had aneurysmal rebleeding. All 5 aneurysms were completely occluded on angiographic follow-up (range, 3-22 mo). One patient had permanent intraprocedural in stent thrombosis and brain infarction. One patient had spontaneous nonaneurysmal intracerebral hemorrhage 1 mo after FD treatment. External ventricular drainage was inserted in 3 patients and ventriculoperitoneal shunt in 2 patients without hemorrhagic complications despite dual antiplatelet therapy. CONCLUSION FD could be considered as a treatment option for ruptured fusiform aneurysms located on PCA, PICA, or SCA when other treatment options are challenging.

scholarly journals A Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery

2001 ◽  
Vol 7 (3) ◽  
pp. 253-257 ◽  
Author(s):  
A.G. Taylor ◽  
M. Tymianski ◽  
K. terBrugge
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cerebral Angiography ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Posterior Circulation ◽  
Surgical Clipping ◽  
Cerebellar Artery ◽  
Dissecting Aneurysms

Dissecting aneurysms occur when blood extrudes into the wall of a vessel. Posterior circulation dissections are recognised as an important cause of cerbral infarction and subarachnoid haemorrhage(SAH), however posterior inferior cerebellar artery (PICA) aneurysmal dissections are rare. A 49-year-old man who presented with SAH was found to have a left PICA dissection on cerebral angiography. The lesion was treated with surgical clipping proximal to the dissection and a distal PICA to PICA anastomosis. The pathology, diagnosis, presentation and treatment of these difficult lesions is discussed.

scholarly journals Posterior circulation aneurysms: A 10-year institutional analysis

2012 ◽  
Vol 01 (02) ◽  
pp. 119-123
Author(s):  
Saurabh Sharma ◽  
Ansari Abuzer ◽  
Ashish Suri ◽  
Shailesh Gaikwad ◽  
N.K. Mishra ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Poor Grade ◽  
Cranial Nerve Palsies ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysms ◽  
Grade Ii ◽  
Multimodality Approach

Abstract Aneurysms are uncommon and challenging to manage. A retrospective study was designed to report 53 patients who are treated from June 2002 to June 2011. The mean age at presentation was 46.34 ± 13.67 years (males, 26). Clinical features included subarachnoid hemorrhage (median Hunt and Hess Grade II, n = 42), cranial nerve palsies (9), hydrocephalus (5), and incidentally diagnosed (5). Locations included superior cerebellar artery (3), posterior cerebral artery (2), basilar trunk (4), vertebral (8), anterior inferior cerebellar artery (AICA) (5), posterior inferior cerebellar artery (PICA) (13), vertebrobasilar junction (6), and basilar top (13). Management included both endovascular intervention (26) and surgery (19), and both (2). Five patients presented as poor grade and underwent only extraventricular drain placement while one patient had thrombosed aneurysm and was managed conservatively. Mortality was 26.4% (n = 14) and morbidity included vasospasm (10), meningitis (2), pseudomeningocele (2), pneumonitis (2), and myocardial infarction (1). Posterior circulation aneurysms are highly challenging. They require the multimodality approach, and decision regarding surgery or embolization has to be individualized.

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