Delusional Parasitosis in a Patient with an Infarction in the Territory of the Right Posterior Cerebral Artery

Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

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Recurrent transient heading disorientation heralding acute posterior cerebral artery (PCA) infarction

BMJ Neurology Open ◽

10.1136/bmjno-2019-000009 ◽

2019 ◽

Vol 1 (1) ◽

pp. e000009

Author(s):

Yong Chuan Chee ◽

Beng Hooi Ong

Keyword(s):

Case Report ◽

Cerebral Infarction ◽

Cerebral Artery ◽

Transient Ischaemic Attack ◽

Posterior Cerebral Artery ◽

Underlying Mechanism ◽

Unusual Presentation ◽

Topographical Disorientation ◽

Ischaemic Attack ◽

The Right

ObjectiveHeading disorientation is a type of pure topographical disorientation. Reported cases have been very few and its underlying mechanism remains unclear. We report an unusual presentation of a 60-year-old man with recurrent transient heading disorientation heralding an acute posterior cerebral artery infarction.DesignCase report.ConclusionAcquired injury to the right retro-splenial region can result in a specific variant of topographical disorientation known as heading disorientation that may present as an atypical transient ischaemic attack-like symptom heralding acute cerebral infarction.

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GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY AND BASILAR TIP VARIATION

Neurosurgery ◽

10.1227/01.neu.0000338431.70709.81 ◽

2009 ◽

Vol 64 (3) ◽

pp. E564-E565 ◽

Cited By ~ 6

Author(s):

Marco A. Zanini ◽

Vitor M. Pereira ◽

Mauricio Jory ◽

José G.M.P. Caldas

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Superior Cerebellar Artery ◽

Fusiform Aneurysm ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion ◽

The Right ◽

Double Origin

Abstract OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life. CONCLUSION To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1–P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

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Competitive flow diversion of multiple P1 aneurysms: proposed classification

BMJ Case Reports ◽

10.1136/bcr-2019-015581 ◽

2020 ◽

Vol 13 (6) ◽

pp. e015581

Author(s):

Mark Alexander MacLean ◽

Thien J Huynh ◽

Matthias Helge Schmidt ◽

Vitor M Pereira ◽

Adrienne Weeks

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Flow Diversion ◽

Endovascular Coiling ◽

Ruptured Aneurysms ◽

The Right

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.

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Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

Case Reports in Neurology ◽

10.1159/000452942 ◽

2016 ◽

Vol 8 (3) ◽

pp. 258-263

Author(s):

Taylor J. Bergman ◽

Rachael C. Saporito ◽

Thomas Hope

Keyword(s):

Computed Tomography ◽

Cerebral Artery ◽

Collateral Circulation ◽

Posterior Cerebral Artery ◽

Cerebral Arteries ◽

Superior Cerebellar Artery ◽

Neurological Intensive Care Unit ◽

Recent Onset ◽

Neurological Intensive Care ◽

The Right

Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

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3T MRI — 3D DSA Fusion Technique on Posterior Cerebral Artery Dissecting Aneurysm: Understanding a Potential Pathophysiologic Mechanism

Interventional Neuroradiology ◽

10.1177/159101990601200303 ◽

2006 ◽

Vol 12 (3) ◽

pp. 215-221 ◽

Cited By ~ 3

Author(s):

W.K.W. Chong ◽

S.K. Lee ◽

K.G. terBrugge

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Free Edge ◽

Dissecting Aneurysm ◽

Vascular Lesions ◽

3T Mri ◽

Pathophysiologic Mechanism ◽

Anatomical Relationship ◽

Fusion Images ◽

The Right

We aimed to show the anatomical relationship between a dissecting aneurysm of the posterior cerebral artery (PCA) and tentorial free edge to understand the pathophysiologic mechanism. A 52-year-old woman with a history of head trauma presented with dizziness and numbness in her left fingers. 3D DSA showed a dissecting aneurysm of the right P2-P3 segment of PCA. The fusion of 3D DSA and 3T MRI was performed at the dedicated workstation using three pairs of landmarks including the ICA termination, MCA bifurcation and A1-A2 junction of the right ACA. Fusion of 3D DSA and 3T MRI clearly demonstrated the dissected segment of PCA crossed the tentorial free edge twice. The fusion images support the direct trauma hypothesis of dissecting aneurysm of the P2-P3 segment of PCA. This novel imaging technique shows future potential to be used to understand the anatomical relationships between various vascular lesions and surrounding structures.

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Prosopagnosia with normal discrimination of unknown faces. Report of a case with occlusion of the lateral branch of the right posterior cerebral artery.

Higher Brain Function Research ◽

10.2496/apr.7.160 ◽

1987 ◽

Vol 7 (2) ◽

pp. 160-166 ◽

Cited By ~ 6

Author(s):

Akira Tamai ◽

Hosaku Torii ◽

Hideaki Enokido ◽

Saburo Matsubara ◽

Eisaku Mihara

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Lateral Branch ◽

The Right

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Coronary stent embolism to the right posterior cerebral artery

Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology ◽

10.5543/tkda.2019.57070 ◽

2020 ◽

Author(s):

sinan varol

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Coronary Stent ◽

The Right

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Republished: Competitive flow diversion of multiple P1 aneurysms: proposed classification

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015581.rep ◽

2020 ◽

Vol 12 (9) ◽

pp. e7-e7

Author(s):

Mark Alexander MacLean ◽

Thien J Huynh ◽

Matthias Helge Schmidt ◽

Vitor M Pereira ◽

Adrienne Weeks

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Posterior Cerebral Artery ◽

Flow Diversion ◽

Endovascular Coiling ◽

Ruptured Aneurysms ◽

The Right

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.

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Cerebral Artery Aneurysm Masquerading as Ptosis in a Child

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v10i2.19951 ◽

2018 ◽

Vol 10 (2) ◽

pp. 193-195

Author(s):

Sanket Parajuli ◽

Pooja Shrestha ◽

Sunita Koirala

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Artery Aneurysm ◽

University Hospital ◽

Ocular Motility ◽

Mri Angiography ◽

History Of ◽

Upper Lid ◽

The Right ◽

Cerebral Artery Aneurysm

An 8-year-old female presented to Eye OPD of Dhulikhel Hospital, Kathmandu University Hospital, with drooping of the right upper lid and inability to move right eye ball since 3 days. She had no history of trauma or fall injury. On ocular examination, visual acuity was 6/6 on both eyes and there was severe ptosis on the right eye in which eyeball remained abducted with restriction of ocular motility on all gazes. The pupil was dilated and 6mm on the right eye in room light. Posterior segment examination was normal. MRI angiography was done which revealed a right Posterior cerebral artery aneurysm.

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