A case of bilateral dissecting aneurysms of the posterior inferior cerebellar artery

Abstract

Objectives: Dissecting aneurysms (DAs) truly localized at the posterior inferior cerebellar artery (PICA) are rare. In addition, bilateral dissecting aneurysms of PICA have never been reported in the literature to our knowledge. We report a case of bilateral DAs of the PICA presented with subarachnoid hemorrhage. Case presentation: A 41-year-old male was referred to the emergency care center of our institute due to sudden onset of posterior cervical pain and dizziness. He was neurologically intact with clear consciousness. CT showed subarachnoid hemorrhage (Fisher Grade 3), and cerebral angiography revealed DAs at anterior medullary segment to lateral medullary segment of bilateral posterior inferior cerebellar artery. He underwent parent artery occlusion (PAO) for the right lesion which showed increase in size during conservative treatment. In spite of negative result of preoperative balloon test occlusion of the right vertebral artery at the origin of the right PICA, he suffered acute infarction in the right cerebellum and medulla after PAO with temporary partial right Wallenberg syndrome and the right limb ataxia. The left lesion showed spontaneous decrease in size at 6 months follow-up angiography. Conclusions: An extremely rare case of bilateral DAs of the PICA is presented. Endovascular treatment for this lesion is feasible though more prudent preoperative evaluation is required.