![]() This exam demonstrated a pseudoaneurysm on the tonsillar branch of the right PICA (fig. An external ventricular drainage was placed and a second cerebral angiography was carried out 1 week later. Cerebral angiography carried out at the time of the initial presentation was negative but performed in bad conditions because of a psychomotor agitation of the patient. Before cerebral angiography, an external ventricular drainage was performed. ![]() CT of the brain showed diffuse SAH with blood in the fourth ventricle and ventricular enlargement. 2a, b).Ī 66-year-old man with a history of arterial hypertension developed a severe headache accompanied by nausea, vomiting and confusion. Angiographic and clinical follow-up 1 and 3 years later showed a complete occlusion of the lesion and a complete recovery (fig. The patient’s postoperative course was unremarkable, and she was discharged without any neurological symptoms. Endovascular treatment was performed just after angiography: a microcatheter was advanced under fluoroscopic control in the right PICA afterwards, 3 coils (Boston Scientific Corporation®) were deployed in the pseudoaneurysm to occlude it. 1), was located below the foramen magnum on the ascending part of the PICA. 1), and the pseudoaneurysm, extracranial but intradural (fig. The origin of the PICA was extradural at the level of the first cervical vertebra (fig. Cerebral angiography revealed a 6-mm-large dissecting aneurysm of the right PICA. Computed tomography (CT) scanning showed SAH predominating in the posterior fossa. Hospitalized few hours later, she did not present any neurological deficit but a very intense headache and mild neck stiffness. is a 40-year-old woman who experienced a sudden headache during a sexual relation, and then she lost consciousness for a while. The long-term clinical results depend mainly on the clinical status on admission. In the group of patients presenting SAH, endovascular treatment was safe and effective. The treatment depends on the existence of a hemorrhagic event. Conclusion: Clinical course and prognosis are variable in PICA dissections. A good recovery was achieved for 4 patients (modified Rankin Score 0) one patient who presented SAH and who was in bad clinical state on admission had a Glasgow Outcome Score of 3 and a modified Rankin Score of 4 three years later. We assessed the long-term results with the Glasgow Outcome Score and the modified Rankin Score. The angiographic and clinical follow-up lasted more than 3 years. Three patients presented acute hydrocephalus and were treated with surgical derivation. No ischemic complication and no rebleeding were observed after sacrifice of the PICA. The others presented subarachnoid hemorrhage (SAH) and were treated by embolization (endovascular sacrifice of the PICA). One patient presented ischemic manifestations he was treated with heparin. The diagnosis was carried out by cerebral angiography in all the cases: in 4, angiography showed focal stenosis with saccular or fusiform dilatation of the artery at the site of the dissection in 1 a double lumen aspect was described. No predisposing factor or traumatic cause was described in the other cases. Two patients presented symptoms after cervical manipulation. Methods and Results: From 1999 to 2003, five patients (40–71 years old) were hospitalized for PICA dissection. The aim of the study was to investigate the clinical manifestations, the neuroradiological aspects and the treatment of 5 cases collected in 5 years. ![]() Background and Purpose: Spontaneous isolated posteroinferior cerebellar artery (PICA) dissection is very rare. ![]()
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