Dissection of the Posteroinferior Cerebellar Artery: Clinical Characteristics and Long-Term Follow-Up in Five Cases

Abstract

Background and Purpose: Spontaneous isolated posteroinferior cerebellar artery (PICA) dissection is very rare. The aim of the study was to investigate the clinical manifestations, the neuroradiological aspects and the treatment of 5 cases collected in 5 years. Methods and Results: From 1999 to 2003, five patients (40–71 years old) were hospitalized for PICA dissection. Two patients presented symptoms after cervical manipulation. No predisposing factor or traumatic cause was described in the other cases. 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. One patient presented ischemic manifestations; he was treated with heparin. The others presented subarachnoid hemorrhage (SAH) and were treated by embolization (endovascular sacrifice of the PICA). No ischemic complication and no rebleeding were observed after sacrifice of the PICA. Three patients presented acute hydrocephalus and were treated with surgical derivation. The angiographic and clinical follow-up lasted more than 3 years. We assessed the long-term results with the Glasgow Outcome Score and the modified Rankin Score. 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. Conclusion: Clinical course and prognosis are variable in PICA dissections. The treatment depends on the existence of a hemorrhagic event. In the group of patients presenting SAH, endovascular treatment was safe and effective. The long-term clinical results depend mainly on the clinical status on admission.

Treatment of dissecting aneurysms of the PICA: Anatomical considerations and clinical outcome

“…All nine surviving patients showed a favorable outcome at six months follow-up, without significant neurological sequelae. The favorable outcome in this series of patients is in concordance with other studies reporting on well-tolerated occlusion of the PICA [4,5,13,14]. The choice of embolic agent (coil or glue) was made based on the local vascular anatomy.…”

Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection

“…Non-invasive diagnostic tools, therefore, are more valuable [3,5,20]. Until recently, spontaneous isolated dissection of the PICA was considered very rare [21]. However, according to our results, isolated unruptured PICA dissections were confirmed in 26.5 % of patients (Fig.…”

Isolated PICA Dissection: An Unusual Complication of Scuba Diving

“…one case of pICA dissection has been reported after a direct trauma related to transoral tumor biopsy [13]. Two cases of isolated pICA dissection after cervical manipulation have been described [14].…”