PMC5726839_01
- Diffusion Weighted Image showing A & B) spotty high signal in bilateral cerebellar hemispheres and vermis of the cerebellum, pons, right thalamus (arrow); C) with left occipital high-intensity (arrow). D) Digital subtraction angiography showed right vertebral artery and basilar artery stenosis (arrow) and E) left vertebral artery distal was totally occluded. F) Left vertebral artery, basilar artery, bilateral inferior cerebellar artery, and bilateral superior cerebellar artery were visible after left vertebral artery recanalization.
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F1
He underwent left vertebral artery angioplasty on January 13, 2013 (Figure 1) and the symptoms improved significantly after stenting.
PMC5726839_02
- Diffusion Weighted Image shows A) high-intensity bilateral symmetric round infarctions (arrow). B) MRA shows that the right vertebral artery is invisible, severe stenosis of the segment from the left vertebral artery distal to the basilar artery or occlusion (lower arrow). C) Cerebral angiography shows diffuse severe stenosis from the V4 segment of the left vertebral artery to the proximal end of the basilar artery and moderate stenosis at the origin of the right AICA (arrow). D) The stenosis was relieved following stent implantation (arrow) in the inferior segment of the basilar artery and the stenosis of the right vertebral artery. artery stenosis (arrow).
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F2
However, serious limbs and trunk ataxia persisted when he was discharged (Figure 2) .
PMC5726839_03
- Diffusion Weighted Image shows A) high-intensity areas in the bilateral middle cerebellar peduncles (arrow). B) Bilateral middle cerebellar peduncle shows symmetrical hypodensity areas on T1-weighted images (arrow). C) MRA shows that bilateral vertebral artery is invisible and the basilar artery at the end of the vertebral artery can be visualized (arrow). Bilateral anterior inferior cerebellar artery, superior cerebellar artery and posterior cerebral artery are not invisible. D) Cerebral angiography showed occlusion of the V5 segment (arrow)of the right vertebral artery, moderate to severe stenosis of the left vertebral artery, basal segment of the basilar artery shows swelling, bilateral superior cerebellar artery visible but obviously thin, the right posterior cerebral artery is invisible and moderate to severe stenosis of the left posterior cerebral artery.
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F3
Diffusion weighted image (DWI) examination is shown in Figure 3.
PMC5726839_04
- CT scan showed A) patchy low-density foci in the left cerebellar hemisphere (arrow). B & C) MR shows low signal intensity from bilateral middle cerebellar (arrow). D) MRA shows bilateral vertebral artery stenosis (arrow).
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F4
Diffusion Weighted Image examination is shown in Figure 4.