PMC5364926_01
Diffusion weighted magnetic resonance imaging showing multiple fresh infarct spots in both cerebellar hemispheres.
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F1
MRI showed multiple acute infarctions in the bilateral cerebellar hemispheres (Fig. 1).
Left vertebral artery angiogram showing segmental elongation of the lower limb of the left VA fenestration (A), which showed a focal defect of the contrast media in the early phase (arrow) and delayed pooling of the contrast media (double arrows) after head rotation to the right (B).
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F2
Interestingly, digital subtraction angiography (DSA) showed segmental elongation of the lower limb of the left VA fenestration (Fig. 2A), with a focal defect of the contrast media in the early phase and delayed pooling of the contrast media after head rotation to the right (Fig. 2B).
Computed tomographic angiogram (A: posterior to anterior view, B: axial view) showing the marked stretching of the left VA fenestration, and the lower limb was compressed between C1 transverse process and C2 lateral mass in head rotation to the right (arrow). Note that bony structure of C1 is a translucent image (blue) so that it enables to view the VA stretching clearly.
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F3
Moreover, CTA clearly showed marked stretching and sliding of the left VA fenestration, and the lower limb was compressed between the C1 transverse process and C2 lateral mass in head rotation to the right (Fig. 3).
Postoperative computed tomographic angiogram (A: posterior to anterior view, B: axial view) showing that the lower limb of VA was no longer compressed between C1 transverse process and C2 lateral mass in head rotation to the right (arrow). Note that bony structure of C1 is a translucent image (blue).
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F4
Postoperative course was uneventful and there was no longer compression of the inferior limb of the VA between C1 and C2 during head rotation after the surgery (Fig. 4).