PMC6744788_01
(a) Magnetic resonance diffusion-weighted imaging shows acute cerebral infarction in the left lateral medulla. (b) Magnetic resonance angiography shows irregularities of the vessel wall (arrow) suggestive of dissection in the left vertebral artery. No abnormal findings are observed in the right vertebral artery.
SNI-10-126-g001.jpg
PMC6744788_01_SNI-10-126-g001.jpg
F1
The MRI findings were the same as those observed at the other hospital; that is, a left lateral medullary infarction due to the left VAD was observed, and there were no abnormal findings in the right vertebral artery [Figure 1a and b].
(a) Plain computed tomography (CT) shows diffuse subarachnoid hemorrhage, mainly in the posterior cranial fossa. (b) Three-dimensional CT angiography shows a dissecting aneurysm (arrow) with active extravasation of contrast agent (arrowhead) in the right vertebral artery distal to the posterior inferior cerebellar artery. An: Aneurysm; BA: Basilar artery; Lt. VA: Left vertebral artery; Rt. PICA: Right posterior inferior cerebellar artery; Rt. VA: Right vertebral artery.
SNI-10-126-g002.jpg
PMC6744788_01_SNI-10-126-g002.jpg
F2
Head computed tomography (CT) showed SAH, mainly in the posterior cranial fossa [Figure 2a]. Three-dimensional CT angiography revealed a dissecting aneurysm with active extravasation of contrast agent in the right vertebral artery distal to the posterior inferior cerebellar artery [Figure 2b].
(a) The right anterior oblique view of the right vertebral artery angiography. A dissecting aneurysm (arrow) is observed in the right vertebral artery distal to the posterior inferior cerebellar artery. The arrowhead indicates the right posterior inferior cerebellar artery. (b) The right anterior oblique view of the right vertebral artery angiography after internal trapping. The dissecting aneurysm of the right vertebral artery is completely embolized by coils (arrow), and blood flow of the right posterior inferior cerebellar artery is preserved (arrowhead). (c) Anteroposterior view of the left vertebral artery angiography after internal trapping. The moderate stenosis of the left vertebral artery due to dissection is observed (arrowhead), but the basilar artery is visualized in antegrade with no delay of blood flow. (d) Magnetic resonance angiography approximately 1 month after onset. The stenosis of the left vertebral artery due to dissection has resolved (arrowhead).
SNI-10-126-g003.jpg
PMC6744788_01_SNI-10-126-g003.jpg
F3
Under general anesthesia, emergency internal coil trapping was performed for the dissecting aneurysm of the right vertebral artery [Figure 3a and b]. The left vertebral artery angiography after internal trapping showed moderate stenosis of the left vertebral artery corresponding to the dissection site, but the basilar artery was visualized in antegrade with no delay of blood flow, endovascular treatment for this stenotic portion was not performed [Figure 3c]. The stenosis of the left vertebral artery due to dissection had resolved on head magnetic resonance angiography (MRA) performed approximately 1 month after onset [Figure 3d].