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KMID : 1034720190110020149
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Journal of Neurosonology and Neuroimaging
2019 Volume.11 No. 2 p.149 ~ p.153
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Bilateral PICA Territory Infarcts of Right Lateral Medulla and Left Cerebellum via Spontaneous Common PICA Dissection
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Jeon Kip-Young
Lee Chong-Hwee
Lee Ki-Jeong
Choi Hyun-Seok
Kim Bum-Soo
Ko Young-Jin
Koo Ja-Seong
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Abstract
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Bilateral cerebellar infarcts in posterior inferior cerebellar artery (PICA) territories have been previously reported and the common PICA (c-PICA) on one side was proposed as a possible mechanism. We report a case of bilateral PICA territory infarcts involving right lateral medulla and left cerebellum via spontaneous c-PICA dissection. Digital subtraction angiography (DSA) revealed that bilateral PICAs originated from the c-PICA arising from the right vertebral artery with luminal irregularity. Eccentric enhancement of the c-PICA on 3D multi-planar reformatted images suggested arterial dissection or atherosclerosis rather than vasculitis. Susceptibility-weighted image showed a blooming effect around the c-PICA and the phase map revealed eccentric high signal intensity on the vessel wall of the c-PICA, implicating intramural thrombus in c-PICA dissection. We investigated the mechanism and etiology of bilateral PICA territory infarcts using DSA and high-resolution magnetic resonance imaging (MRI) and elucidated the dissection of the c-PICA.
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KEYWORD
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Cerebellar infarct, Lateral medullary infarct, Common PICA, Arterial dissection, High-resolution MRI
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