PMC6016850_01
CT Stroke Protocol at time of presentation. A.) 4D CTA demonstrating top of the basilar occusion and poor flow in the right vertebral artery; B.) coronal CA demonstrating dissection of verterbral arteries at the C1-C2 level, particularly prominent on the right; C.) relative blood volume; and D.) corrected relative blood volume.
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F1
Upon arrival in the emergency department, a CT stroke protocol was performed which demonstrated bilateral severe distal cervical vertebral artery dissections with acute thrombotic emboli seen in the left cervical vertebral artery (Figures 1 and 2).
CT Stroke Protocol with perfusion imaging demonstrating primary involvement of occipital lobe, cerebellum, and brainstem. Perfusion imaging reflecting rCBV, TTP, rCBF, MTT, and delay (from top-left to bottom-right).
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F2
Upon arrival in the emergency department, a CT stroke protocol was performed which demonstrated bilateral severe distal cervical vertebral artery dissections with acute thrombotic emboli seen in the left cervical vertebral artery (Figures 1 and 2).
Digital subtraction angiography at time of presentation demonstrating A.) anterior-posterior view showing basilar and PICA occlusion, B.) lateral view showing basilar and PICA occlusion, C.) left vertebral artery dissection, and D.) right vertebral artery dissection.
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F3
No filling was observed in the right PICA territory (Figure 3).
Immediate post-procedure magnetic resonance imaging demonstrating ischemic stroke within the cerebellum, brainstem, and left occipital cortex. A.) attenuated diffusion coefficient (ADC) sequence capturing left occipital stroke and B.) diffusion-weighted imaging capturing cerebellar, brainstem, and left occipital cortex stroke.
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F4
MRI Brain with and without contrast for assessment of brainstem integrity and cerebrovascular status prior to transport to the intensive care unit. MRI demonstrated extensive areas of restricted diffusion accompanied by perfusion abnormalities consistent with acute infarction of the posterior circulation, specifically within the bilateral cerebellar hemispheres, right medulla, pons bilaterally, midbrain, thalami, and left occipital lobe (Figure 4).