PMC4033783_01
(a) CT on admission showing SAH and ventricular enlargement. (b) 3D-CTA showing a dissecting aneurysm of the right VA (arrow). Origin of PICA is demonstrated (arrowhead). The right VA is thicker than the left
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F1
Computed tomography (CT) demonstrated SAH and ventricular enlargement [Figure 1a]. Three-dimensional CT angiography (3D-CTA) revealed a dissecting aneurysm of the right VA proximal to PICA [Figure 1b].
(a) Angiogram showing a dissecting aneurysm (arrow) in the right VA proximal to PICA (arrowheads). (b) Postoperative right VAG demonstrating complete occlusion of the aneurysm and VA. (c) Left VAG showing opacification of the distal right VA and right PICA via blood flow through the VA union
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F2
On an angiogram, the right VA was dominant and thicker than the left [Figure 2a]. A postoperative angiogram [Figure 2b] showed complete occlusion of the right VA proximal to PICA including the dissecting aneurysm. Left vertebral angiography (VAG) revealed opacification of the distal right VA and right PICA [Figure 2c].
(a) CT obtained on the 15thday after VA occlusion showing hemorrhage in the right cerebellar hemisphere. (b) Angiogram after cerebellar hemorrhage showing no recanalization of the right VA including the dissecting aneurysm and preserved right PICA
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F3
CT demonstrated right cerebellar hemorrhage [Figure 3a]. The right PICA was patent and fed by retrograde blood flow from the contralateral VA [Figure 3b].