PMC7568148_01
Noncontrast CT of the head (a) and brain MRI-DWI sequence (b) showing several well-circumscribed near fluid attenuation regions in the left cerebellum, the largest of which measures 3.5 cm transverse diameter. This is suggestive of left cerebellar ischemic stroke. There is no acute hemorrhage, midline shift, or hydrocephalus.
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CT head/brain without IV contrast showed nonspecific left cerebellar hypodensities that may represent age-indeterminate embolic infarcts/injuries among other possible etiologies, with no acute intracranial hemorrhage (Figures 1(a) and 1(b)).
CTA shows a short segment of high-grade narrowing of the cervical right vertebral artery at the C2-3 level.
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CT angiography of the head and neck with and without IV contrast demonstrated a relatively abrupt change in the caliber of the left V3 vertebral artery suggestive of dissection and a short segment high-grade narrowing of the right vertebral artery also highly suggestive of a dissection (Figure 2).
Cerebral angiography showing a dissection flap extending across the C1 loop and to the foramen magnum. Subintimal clot is seen medially in the vessel wall with 50% loss of lumen in the V4 segment. This abrupt change in the caliber of the left vertebral artery shows dissection.
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The exam confirmed the bilateral VAD and revealed the presence of a subintimal clot on the left VA at V4 with loss of 50% of lumen (Figures 3 and 4), not previously observed in previous images.
Cerebral angiography shows right vertebral artery dissection right past the C3 level at which a small pseudoaneurysm is noted in the artery anterior wall. This pseudoaneurysm tapers into the dissection which extends just beyond the C2 loop. There is marked reduction in luminal diameter and noticeable delay in antegrade flow distal to the dissection.
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The exam confirmed the bilateral VAD and revealed the presence of a subintimal clot on the left VA at V4 with loss of 50% of lumen (Figures 3 and 4), not previously observed in previous images.
MR angiogram at 3-month follow-up showed complete resolution of bilateral dissection.
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MR angiography after three months showed complete resolution of the dissection (Figure 5).