A 56-year-old male patient came to the emergency room due to a right-sided occipital headache and vertigo, which suddenly began three days before the visit, and a symptom of tilting to the right, which began one day before the visit. There was no history of an external injury within the past one week. The patient did not have any underlying diseases, history of migraines, or risk factors for stroke, except for smoking. He also did not have a history of taking antiplatelet agents. When the patient visited the emergency room, his blood pressure was 160/100 mmHg, the pulse rate was 62/min, breathing rate was 19/min, and body temperature was 36.5 °C. The results of a neurological examination showed lateropulsion to the right side, hypoesthesia on the right side of the face, ataxia in the right upper and lower limbs, and the NIH stroke scale was 2. The results of serological studies and electrocardiography were normal.\nThe diagnosis was determined to be an acute ischemic stroke because the diffusion weighted imaging (DWI) of MRI revealed a high signal intensity area in the right lateral medulla. CT angiography (CTA) was taken first at 3 days after the symptom occurred. HR vw-MRI was taken a day after (at the 4th-day). The right PICA was not observed in the first CTA, and partial spontaneous recanalization was observed on the time-of-flight MR angiography (TOF-MRA), which was taken one day after. Moreover, the sagittal 3D T1 weighted HR vw-MRI showed a T1 hyperintense intramural hematoma in the right proximal PICA (Fig. ). However, a T2 weighted 3D curved MPR image revealed the luminal dilation and intimal flap in the right proximal PICA (Fig. ). The patient was diagnosed with spontaneous isolated PICA dissection on the basis of the neurological symptoms and imaging. He was treated with antiplatelet agents and the neurological symptoms of the patient improved during course of admission.
A 42-year-old man with no past significant medical illness presented with headache. CT scan done showed subarachnoid hemorrhage (SAH) predominantly in the perimesencephalic cisterns []. Magnetic resonance imaging T1 gradient sequence also showed the hypointense signal suggestive of blood products in the perimesencephalic cisterns []. Fetal posterior cerebral arteries are seen on both the sides arising from the internal carotid artery [Figures and ]. DSA (digital subtraction angiogram) done subsequently revealed fusiform bulbous dilation involving both the cisternal and cortical segments of the left SCA []. Endovascular treatment in the form of parent artery occlusion was done under general anesthesia, with complete exclusion of the aneurysm from the circulation as seen on post-coiling angiogram []. Standard heparin protocol was followed and activated clotting time greater than 250 s was maintained during the procedure. Six-French (6F) Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 microcatheter (ev3) and transcend 0.014 microwire (Stryker) were used to access the aneurysms. Multiple Axium (ev3) coils were used to occlude the aneurysm. There were no intra- and periprocedural complications and patient was discharged on the 5th day after operation. The post-operative course was uneventful. The patient's neurological examination after 1 month was completely normal. Control angiogram done after 1 year showed stable occlusion of the aneurysm with endovascular coil in place [].