Case Report: Bow Hunter's Syndrome Caused by Compression of Extracranially Originated Posterior Inferior Cerebellar Artery

Bow hunter's syndrome (BHS) is most commonly caused by compression of the vertebral artery (VA). It has not been known to occur due to an extracranially originated posterior inferior cerebellar artery (PICA), the first case of which we present herein. A 71-year-old man presented with reproducible dizziness on leftward head rotation, indicative of BHS. On radiographic examination, the bilateral VAs merged into the basilar artery, and the left VA was predominant. The right PICA originated extracranially from the right VA at the atlas–axis level and ran vertically into the spinal canal. During the head rotation that induced dizziness, the right PICA was occluded, and a VA stenosis was revealed. Occlusion of the PICA was considered to be the primary cause of the dizziness. The patient underwent surgery to decompress the right PICA and VA via a posterior cervical approach. Following surgery, the patient's dizziness disappeared, and the stenotic change at the right VA and PICA improved. The PICA could be a causative artery for BHS when it originates extracranially at the atlas–axis level, and posterior decompression is an effective way to treat it.

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Use of the Coupler Microanastomotic Device for the Treatment of a Distal Posterior Inferior Cerebellar Artery Aneurysm Via Excision and End-to-End Anastomosis—A Case Report

Neurosurgery Open ◽

10.1093/neuopn/okaa002 ◽

2020 ◽

Vol 1 (2) ◽

Author(s):

Oded Goren ◽

Raghuram Sampath ◽

Akshal S Patel ◽

Christoph J Griessenauer ◽

Clemens M Schirmer ◽

...

Keyword(s):

Case Report ◽

Intracranial Aneurysms ◽

Clinical Presentation ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Parent Vessel ◽

First Case ◽

Cerebellar Artery ◽

End To End ◽

Coupler Device

ABSTRACT BACKGROUND AND IMPORTANCE The Coupler microanastomotic device (Medical Companies Alliance, Birmingham, Alabama) aims at facilitating safe and efficient end-to-end reconstruction of the native vessel ends following resection of intracranial aneurysms. CLINICAL PRESENTATION We report the first case of the Coupler device used to treat a ruptured posterior inferior cerebellar artery (PICA) aneurysm. Following aneurysmal trapping and excision, the native parent vessel ends were connected in an end-to-end fashion. CONCLUSION The microanastomotic Coupler device is an acceptable option for end-to-end anastomosis and was successfully applied in the management of a ruptured fusiform PICA aneurysm.

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Transitional nystagmus in a Bow Hunter’s Syndrome case report

BMC Neurology ◽

10.1186/s12883-020-02009-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yasuyuki Nomura ◽

Teruo Toi ◽

Yasuo Ogawa ◽

Takeshi Oshima ◽

Yuichiro Saito

Keyword(s):

Head Rotation ◽

Final Diagnosis ◽

Central Position ◽

Downbeat Nystagmus ◽

Video Record ◽

First Case ◽

Healthy Side ◽

The Right ◽

Cervical Diseases ◽

Hunter's Syndrome

Abstract Background Bow Hunter’s Syndrome (BHS) is known as one of cervical diseases which causes vertigo, but the details of its vertigo, especially nystagmus and eye movement, are still incompletely understood. This time, we reported the first case of BHS with a nystagmus chart with video record of transitional nystagmus. Case presentation The patient, a 47-year-old female, complained of vertigo caused by head rotation. When she turned her head leftward, leftward nystagmus appeared, and this was followed by dullness of the right arm. After her head was returned to the central position, downbeat nystagmus appeared, which changed to rightward nystagmus. She was diagnosed with BHS by her symptoms and images. We recorded a nystagmus video and nystagmus chart of this transitional nystagmus including downbeat nystagmus. Her vertigo was cured by the modification of a prescription for her past medical history: hypertension. Conclusion The vertigo of BHS accompanies nystagmus. In this present case, the transitional nystagmus was observed, and it occurred toward the healthy side. Then the nystagmus direction was changed to the affected side via downbeat nystagmus. This is the first report with both a nystagmus chart with video of BHS. Nowadays, various kinds of vertigo induced by neck movement are known. BHS is a rare disease among vertigo diseases, but we should consider it as a different diagnosis of vertigo patients. A precise interview and proper examination are required to make the final diagnosis.

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Case Report: Endovascular Treatment of a Giant Distal PICA Aneurysm in Association With a Cerebellar AVM: A Report on Treatment Considerations and a Literature Review

Frontiers in Neurology ◽

10.3389/fneur.2020.611377 ◽

2020 ◽

Vol 11 ◽

Author(s):

Hassan A. Khayat ◽

Christine M. Hawkes ◽

Almunder R. Algird

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Superior Cerebellar Artery ◽

Management Approach ◽

Parent Vessel ◽

Cerebral Angiogram ◽

First Case ◽

Cerebellar Artery ◽

Risk Of Rupture ◽

The Right ◽

Pica Aneurysms

Background: Distal posterior inferior cerebellar artery (PICA) aneurysms are uncommon intracranial vascular lesions. The coincidence of these aneurysms and Arteriovenous malformation (AVM) is even more rare. Since 1956, a total of 57 cases of distal PICA aneurysms associated with AVM have been reported with clear and adequate description. None of these reports describe a giant prenidal aneurysm at this particular location. The paucity of natural history data as well as lack of consensus about treatment strategies in such cases present a significant challenge that requires an individualized management approach.Case Description: A 68-year-old male presented with recurrent episodes of nausea and vomiting precipitated by physical exertion and change of head position. An MRI of the brain demonstrated a giant partially thrombosed right posterior inferior cerebellar artery (PICA) aneurysm with mass effect on the floor of the fourth ventricle. A conventional cerebral angiogram revealed a giant (3.1 x 3.1 x 2.8cm) distal right PICA pre-nidal aneurysm with two smaller distal PICA aneurysms. An AVM (Spetzler-Martin Grade 1) supplied by the right PICA as well as the right superior cerebellar artery (SCA) was also identified on cerebral angiography (not seen on an MRI). Endovascular coil embolization with parent vessel sacrifice was performed to occlude the giant aneurysm. Due to the asymptomatic nature, low risk of rupture, and the patient's age, AVM treatment was deferred.Conclusion: This paper presents the first case of a giant PICA aneurysm associated with cerebellar AVM. For PICA aneurysm-AVM complexes, meticulous evaluation of the morphology, associated anatomy, and comparative risk analysis for both lesions are key for treatment planning. Distal PICA aneurysms can be treated safely with parent vessel occlusion, particularly in the case of prenidal aneurysms.

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Endovascular Management of Complete Vertebral Artery Dissection Presenting with Subarachnoid Haemorrhage

Interventional Neuroradiology ◽

10.1177/159101999900500209 ◽

1999 ◽

Vol 5 (2) ◽

pp. 161-166 ◽

Cited By ~ 4

Author(s):

R.K. Lenthall ◽

B.D. White ◽

N.S. McConachie

Keyword(s):

Subarachnoid Haemorrhage ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Endovascular Techniques ◽

First Case ◽

Surgical Clip ◽

Cerebellar Artery ◽

The Right

Spontaneous vertebral artery (VA) dissection may involve the intradural segment of the VA and result in subarachnoid haemorrhage (SAH). These lesions are frequently associated with recurrent SAH, and have a high mortality. Prior to the development of endovascular techniques the majority of these lesions were treated surgically. In cases where the dissection involved the posterior inferior cerebellar artery (PICA) origin surgery was associated with significant complications including recurrent SAH from retrograde VA flow into the dissected segment above the surgical clip. We describe two cases of complete VA dissection in which the entire intradural VA was sacrificed to prevent recurrent SAH. The first case tolerated planned left PICA occlusion without developing a significant neurological deficit. The second case had infarcted the right PICA territory at presentation.

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Stent-assisted coiling in treating hemorrhagic vertebral artery dissecting aneurysms involving posterior inferior cerebellar artery: a case report

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2014.01407 ◽

2014 ◽

Vol 35 (12) ◽

pp. 1407

Author(s):

Lin-sun DAI ◽

Bao-qiang LIAN ◽

Li-sheng HE ◽

De-zhi KANG

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Cerebellar Artery ◽

Dissecting Aneurysms

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Cerebellar hemorrhage in a newborn: a case report in association with suspected arterial dissection of the posterior inferior cerebellar artery

Child s Nervous System ◽

10.1007/s00381-021-05056-4 ◽

2021 ◽

Author(s):

Miyuki Shimizu ◽

Akira Yamaura ◽

Tadashi Miyagawa

Keyword(s):

Case Report ◽

Posterior Inferior Cerebellar Artery ◽

Arterial Dissection ◽

Cerebellar Hemorrhage ◽

Cerebellar Artery

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Treating a Ruptured Fusiform Aneurysm of the Posterior Inferior Cerebellar Artery (PICA) using PICA-PICA Anastomosis combined with Trapping: A Case Report

Japanese Journal of Neurosurgery ◽

10.7887/jcns.19.420 ◽

2010 ◽

Vol 19 (5) ◽

pp. 420-424

Author(s):

Kenta Aso ◽

Yoshitaka Kubo ◽

Shunsuke Kakino ◽

Hiroshi Kashimura ◽

Atsushi Sugawara ◽

...

Keyword(s):

Case Report ◽

Posterior Inferior Cerebellar Artery ◽

Fusiform Aneurysm ◽

Pica Pica ◽

Cerebellar Artery

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Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery —Case Report—

Neurologia medico-chirurgica ◽

10.2176/nmc.33.634 ◽

1993 ◽

Vol 33 (9) ◽

pp. 634-637 ◽

Cited By ~ 20

Author(s):

Shoichiro KAWAGUCHI ◽

Toshisuke SAKAKI ◽

Kitaro KAMADA ◽

Hideaki IWANAGA ◽

Katsushige TAKEHASHI ◽

...

Keyword(s):

Case Report ◽

Posterior Inferior Cerebellar Artery ◽

Dissecting Aneurysm ◽

Cerebellar Artery

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Adenomatoid odontogenic tumor: a report of two unusually large lesions in the mandible

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.188 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S88-S89

Author(s):

A Lazim ◽

R Kuklani ◽

D Sundararajan

Keyword(s):

Benign Neoplasm ◽

Surgical Excision ◽

Odontogenic Tumor ◽

Radiographic Examination ◽

Adenomatoid Odontogenic Tumor ◽

Impacted Tooth ◽

Anterior Maxilla ◽

Recommended Treatment ◽

First Case ◽

The Right

Abstract Introduction/Objective Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic tumor representing 3 to 7% of all odontogenic tumors. This tumor was first reported as adeno-ameloblastoma by Bernier and Tiecke in 1950 as it was initially assumed to be a type of ameloblastoma. In 1969, Philipsen and Bern proposed the term adenomatoid odontogenic tumor which was subsequently adopted by WHO and became the accepted terminology for this tumor. AOT is classified as a tumor of odontogenic epithelium but occasionally abnormal hard tissues consistent with dentinoid material may also be present as part of the tumor. AOT tends to occur in younger patients and 50% of the cases are diagnosed in teenagers. It occurs twice as commonly in females and frequently involves the anterior maxilla. Radiographically, AOT can appear as a radiolucent or mixed lucent-opaque lesion and may be associated with an impacted tooth. Methods/Case Report We report two unusually large expansile lesions of AOT that presented in the mandible. In the first case, the tumor presented as an expansile radiolucent lesion involving the right posterior mandible in a 32 year old female. In the second case, the tumor presented as an expansile mixed lucent-opaque lesion involving the left anterior mandible in a 21 year old female. The clinical presentation, radiographic and imaging findings, histopathologic features and treatment of these two cases will be discussed. The recommended treatment for AOT is surgical excision. The prognosis is good as this tumor seldom recurs after excision. Results (if a Case Study enter NA) NA Conclusion AOT is considered to be a non-aggressive, non-invasive and slow growing benign neoplasm. It is usually discovered on routine radiographic examination as the lesion is usually small and asymptomatic at the time of diagnosis but occasional cases that are larger in size have been reported in the literature.

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