PMC4921184_01
Right cerebellar infarction changes on magnetic resonance (MR) imaging and angiography (MRA). A. Diffusion-weighted imaging revealed an acute infarction change in the right cerebellum with mild fourth ventricle compression. B (MRA) and C (neck angiography) revealed that the RVA was not patent from levels C7 to C11.
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An acute infarction in the right cerebellar area with mild fourth ventricle compression was discovered in the ER using computed tomography (CT) and magnetic resonance imaging (Fig. 1a). The right vertebral artery (RVA) from levels C7 to C1 and the right posterior inferior cerebellar artery were not visualized on the magnetic resonance angiography (MRA) image (Fig. 1b). Two weeks later, during neck angiography exploration, the RVA was perceived not to have opacified from levels C7 to C1 (Fig. 1c).
Focal stenosis as shown via neck angiography. A. Neutral neck angiography showed the patent RVA. B. Neck angiography during ipsilateral neck rotation revealed focal stenosis at the C6-7 level (arrow).
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However, after 1 month, no occlusion of RVA was evident from the frontal view (Fig. 2a), and only partial stenosis at the C6-7 level was revealed in a subsequent right-neck-rotation angiography image (Fig. 2b).
The right vertebral artery flow changed at different ipsilateral rotation angles on the color Doppler ultrasound images. The higher the degree of angle rotation, the lower the blood flow. (A. 0 ; B. 30 ; C. 45 ; D. 50 ; E. 60 w).
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This evaluation revealed that at the C6-7 level junction, RVA flow speed changed at different ipsilateral rotation angles (Figs. 3a-e).
The right vertebral artery (RVA) at the C6-7 level was narrowed due to the impingement of the adjacent lateral osteophyte, as demonstrated on contrast-enhanced CT and 3-dimensional volume-rendering CT angiography (3D-CTA). A. Axial contrast-enhanced CT with right neck rotation showed focal stenosis of RVA with an adjacent prominent lateral osteophyte (arrow). B. 3D-CTA demonstrated the focal stenosis at the C6-7 level with rightward neck rotation (arrow).
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As shown on neck axial rotational contrast-enhanced CT and 3-dimensional volume-rendering CT angiography (3D-CTA) examination, the RVA was found to have a narrowed area only at the C6-7 level, with an adjacent prominent osteophyte of the C6 uncinate process (Figs. 4a, b).