A 38-year-old male patient came to the emergency room due to vertigo and vomiting that had started suddenly one day before the visit. The patient complained of a left-sided occipital headache that began two days before the visit. He had no history of trauma within 1 week prior to admission. The patient did not have any underlying diseases, history of migraines, or risk factors for stroke except for smoking and alcohol consumption. His blood pressure was 170/100 mmHg, the pulse rate was 70/min, breathing rate was 20/min, and body temperature was 36.5 °C. A neurological examination showed ataxia in the left upper extremity and the NIH stroke scale was 1. The results of serological studies and electrocardiography were normal.\nThe patient was determined to have an acute ischemic stroke because the DWI of MRI showed a high signal intensity area in the left PICA territory. CTA was taken at 2 days after the onset of a headache and at 1 day after the onset of neurological symptoms. Moreover, HR vw-MRI was taken at 6 days after the onset of a headache and at 5 days after the onset of neurological symptoms. Although the left PICA was not observed on the TOF-MRA, other vessels including the left vertebral artery were normal. An intraluminal high signal intensity and mild dilation of the left proximal PICA was revealed on routine 3D HR vw-MRI, but pathognomic signs of dissection was not seen. Curved MPR image reconstructed from 3D T2 weighted HR vw-MRI showed dilation and an intimal flap in the left PICA origin and post dilation stenosis in the left proximal PICA (D). (Fig. ). The patient was diagnosed with spontaneous isolated PICA dissection based on the neurological symptoms and imaging. The patient was treated with antiplatelet agents and discharged after his neurological symptoms improved.
A 50-year-old lady, who had a history of hypertension, presented with severe headache and ataxia. CT scan done at admission showed acute right cerebellar hematoma []. DSA done subsequently revealed fusiform aneurysm of the cisternal segment of the SCA []. Endovascular treatment was done under general anesthesia with inside out coiling of the aneurysm with platinum coils []. Standard heparin protocol was followed and an activated clotting time greater than 250 s was maintained during the procedure. 5F Envoy (cordis) guiding catheter was placed in the distal vertebral artery. A combination of echelon-10 micro-catheter (ev3) and transcend 0.014 micro-wire (Stryker) were used to access the aneurysms and multiple axiom (ev3) coils were used to occlude the aneurysm. Post-coiling angiogram showed complete exclusion of the aneurysm from the circulation. The post-operative period was uneventful. The patient's neurological examination done after 1 month was completely normal. Control angiogram done at the end of 1 year showed stable occlusion with no re-canalization of the aneurysm [].