A 70-year-old woman with hypertension, hyperlipidemia, and a history of smoking presented with a peripheral fusiform SCA aneurysm found incidentally during a routine MRI investigation due to “black out” symptoms. The aneurysm was located 2 cm from the SCA origin, and measured 7 mm in maximal diameter [Figure and ]. After a thorough discussion of treatment options, the patient elected to undergo a combined subtemporal, presigmoidal approach. On the lateral aspect of the brainstem, the aneurysm was exposed along with the parent artery and two major efferent branches. One of these branches, the largest one, was superiorly directed and a double, smaller branch, presented inferiorly around the aneurysm fundus. It was necessary during microsurgical dissection to detach the aneurysm dome from the tentorial undersurface as well as from the 4th cranial nerve. Multiple clips were used to reconstruct the aneurysm without intra-operative complication. Intra-operative angiogram confirmed reconstruction of the fusiform aneurysm with preservation of distal flow [Figure –]. The patient tolerated the procedure well and was extubated and returned to the intensive care unit in stable condition. She was discharged home on the fourth post-operative day without new deficit.
A 55-year-old woman visited our ED with a complaint of vertigo and sudden-onset headache. A diffusion-weighted MRI revealed a high-signal intensity lesion in the right cerebellar hemisphere [], leading to the diagnosis of CI. Although depiction of the right PICA was poor, a pathologic process involving the PICA remained unclear []. CTA performed the next day revealed a pearl-string lesion at the orifice of the right PICA [], establishing the diagnosis of a right PICA dissection. The patient recovered uneventfully with conservative management, including administration of aspirin. A repeated CTA obtained a month after admission showed improvement in the stenosis of the PICA distal to the dissection [].