Isolated Posterior Inferior Cerebellar Artery Dissection.

A 52-year-old nonhypertensive man developed sudden vertigo and headache. He showed left-side Horner's syndrome and limb ataxia, decreased superficial sensation in the right side of his face and limbs. Magnetic resonance (MR) imaging revealed lateral medullary infarction (Picture A). Neither MR angiography nor conventional angiography showed apparent sign of dissection (Picture B and C). Eleven days later, MR angiography showed severe stenosis of the left posterior inferior cerebellar artery (PICA) (Picture D), and T1-volume isotropic turbo spin-echo acquisition (VISTA) showed a high-signal-intensity area at the left PICA (Picture E). Thus, isolated left PICA dissection (PICAD) was diagnosed.

Picture.

VISTA is a new useful method to visualize a mural hematoma (1). Isolated PICAD is a rare cause of medullary infarction and may be difficult to diagnose (2). Therefore, VISTA may be useful even when initial radiological findings were insufficient for the diagnosis of PICAD.

The authors state that they have no Conflict of Interest (COI).