Gauthier Duloquin1, Hilde Henon1, Marco Pasi1, Nelly Dequatre1, Lucie Della Schiava1, Gregory Kuchcinski2, Xavier Leclerc2, Charlotte Cordonnier1, Barbara Casolla3,4. 1. Department of Neurology, Univ. Lille, Inserm U1172, CHU Lille, Stroke unit, Lille, France. 2. Department of Neuroradiology and Interventional Neuroradiology, Univ. Lille, Inserm U1172, CHU Lille, Lille, France. 3. Department of Neurology, Univ. Lille, Inserm U1172, CHU Lille, Stroke unit, Lille, France. casolla.b@chu-nice.fr. 4. Stroke Unit, Hôpital Pasteur 2, URRIS - UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France. casolla.b@chu-nice.fr.
Abstract
INTRODUCTION: I ntracranial vertebral dissections have polymorphs clinical presentations and can lead to haemorrhagic complications if they are intracranial. We here describe a case of a thrombosed dissecting aneurysm of postero-inferior cerebellar artery (PICA) revealed by a Wallenberg syndrome preceded by headaches. CASE: A 23-year-old patient, without neurological or vascular past medical history, was admitted for dizziness preceded by headache. The clinical examination on admission revealed an incomplete Wallenberg syndrome, associating hemiface sensitive deficit, Horner's syndrome, dysmetria and nystagmus. The brain MRI showed a latero-medullary infarct with a homolateral PICA thrombosed dissecting aneurysm. CONCLUSION: The diagnosis of intracranial dissecting aneurysms needs particular caution because aneurysm sac thrombosis can give false reassurance on angiographic MR sequences. Moreover, the anatomic features of intracranial artery walls make them prone to sub-adventitial dissection and subsequent subarachnoid haemorrhages. Therefore, antithrombotic therapy should be used with caution, due to the risk of bleeding in these intracranial dissections.
INTRODUCTION: I ntracranial vertebral dissections have polymorphs clinical presentations and can lead to haemorrhagic complications if they are intracranial. We here describe a case of a thrombosed dissecting aneurysm of postero-inferior cerebellar artery (PICA) revealed by a Wallenberg syndrome preceded by headaches. CASE: A 23-year-old patient, without neurological or vascular past medical history, was admitted for dizziness preceded by headache. The clinical examination on admission revealed an incomplete Wallenberg syndrome, associating hemiface sensitive deficit, Horner's syndrome, dysmetria and nystagmus. The brain MRI showed a latero-medullary infarct with a homolateral PICA thrombosed dissecting aneurysm. CONCLUSION: The diagnosis of intracranial dissecting aneurysms needs particular caution because aneurysm sac thrombosis can give false reassurance on angiographic MR sequences. Moreover, the anatomic features of intracranial artery walls make them prone to sub-adventitial dissection and subsequent subarachnoid haemorrhages. Therefore, antithrombotic therapy should be used with caution, due to the risk of bleeding in these intracranial dissections.
Authors: Stéphanie Debette; Annette Compter; Marc-Antoine Labeyrie; Maarten Uyttenboogaart; Tina M Metso; Jennifer J Majersik; Barbara Goeggel-Simonetti; Stefan T Engelter; Alessandro Pezzini; Philippe Bijlenga; Andrew M Southerland; Olivier Naggara; Yannick Béjot; John W Cole; Anne Ducros; Giacomo Giacalone; Sabrina Schilling; Peggy Reiner; Hakan Sarikaya; Janna C Welleweerd; L Jaap Kappelle; Gert Jan de Borst; Leo H Bonati; Simon Jung; Vincent Thijs; Juan J Martin; Tobias Brandt; Caspar Grond-Ginsbach; Manja Kloss; Tohru Mizutani; Kazuo Minematsu; James F Meschia; Vitor M Pereira; Anna Bersano; Emmanuel Touzé; Philippe A Lyrer; Didier Leys; Hugues Chabriat; Hugh S Markus; Bradford B Worrall; Stéphane Chabrier; Ralph Baumgartner; Christian Stapf; Turgut Tatlisumak; Marcel Arnold; Marie-Germaine Bousser Journal: Lancet Neurol Date: 2015-06 Impact factor: 44.182