Do Characteristics of Dissection Differ between the Posterior Inferior Cerebellar Artery and the Vertebral Artery?

Matsumoto, Juntaro; Ogata, Toshiyasu; Abe, Hiroshi; Higashi, Toshio; Takano, Koichi; Inoue, Tatsuo

doi:10.1016/j.jstrokecerebrovasdis.2014.07.013

Cited by 23 publications

(16 citation statements)

References 14 publications

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“…Generally, SAH appears to be a less common finding after VAD, with reports between 0.3 and 14.5% of involved patients [1,19,30] . In the presented cohort, despite the routinely performed blood-sensitive brain imaging, no primary SAH was encountered.…”

Section: Brain Imagingmentioning

confidence: 99%

“…Other causes of false-positive and false-negative dissection findings on MRA include turbulent flow simulating dissection, flowrelated enhancement in the sense of an MR artifact, pulsation artifacts and slow flow in the VA due to other causes [18] . The prevalence of the typical crescent-shaped intramural hematoma, which should be pathognomonic for a mural hematoma, has been reported to be visible in up to 78% of cases, but other studies reported it in only about one-third of patients [1,8,19] . Imaging-based differentiation between a narrowed VA secondary to VAD and a hypoplastic VA (HVA) may be difficult.…”

Section: Vascular Imagingmentioning

confidence: 99%

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Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Günther¹,

Witte²,

Freesmeyer³

et al. 2016

Eur Neurol

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Background/Aims: Vertebral artery dissection (VAD) is an important cause of ischemic stroke. In this observational study, clinical data, magnetic resonance (MR) and ultrasound (US) imaging findings and ischemic patterns were analyzed. Methods: Forty-seven patients with a diagnosis of VAD underwent clinical examination, US, MR of the brain and neck and MR angiography (MRA) of the cervical arteries. Vascular abnormalities and ischemic brain lesions were noted. Data were evaluated separately and compared for spontaneous and traumatic VAD subgroups. Results: The most common overall clinical symptom was vertigo followed by neck pain. In the traumatic subgroup, vertigo was relatively rare (p = 0.022). Most common MRA findings were vessel irregularity and vessel occlusions. Ischemic lesions occurred significantly more frequently after spontaneous than after traumatic VAD (p = 0.009). Unilateral VAD was significantly more common in non-dominant vertebral arteries (p < 0.001). Mortality after trauma was not only due to VAD complications but also due to other trauma-related injuries. Conclusion: The variability of MR and US imaging findings in patients with VAD is illustrated. The algorithm of management should be based on a multimodality approach involving patient history and clinical neurological examination. Several types of vessel abnormalities and ischemic lesion in diverse locations may point to arterial dissection, and the differential diagnosis of VAD must be kept in mind.

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Section: Brain Imagingmentioning

confidence: 99%

Section: Vascular Imagingmentioning

confidence: 99%

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Günther¹,

Witte²,

Freesmeyer³

et al. 2016

Eur Neurol

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“…While dissecting intracranial aneurysms without parent vessel thrombosis are typically surgically occluded acutely, the appropriate management of spontaneously thrombosed dissecting aneurysms in unclear. Dissecting aneurysms are rare entities that predominantly occur in the vertebrobasilar circulation, with isolated PICA dissecting aneurysms comprising an even smaller subset of such lesions 3 5. As such, the natural history and optimal management strategy for these lesions remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Dissecting aneurysms appear most commonly in the vertebrobasilar circulation with a documented incidence of 3.2–4.5% among patients presenting with subarachnoid hemorrhage, the majority of which develop on the vertebral or basilar arteries 1 2. Posterior inferior cerebellar artery (PICA) dissection represents a small subset of these entities with an estimated incidence of 0.5% of subarachnoid hemorrhage patients 3. Although PICA dissecting aneurysms have been previously reported, they rarely present with vessel occlusion 4.…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid hemorrhage then thrombosis of posterior inferior cerebellar artery dissection: is early surgical exploration warranted?

et al. 2015

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The natural history of spontaneous cerebral artery dissection and thrombosis remains uncertain. Concurrent subarachnoid hemorrhage further complicates the therapeutic approach. Thus the best strategy for managing patients with acute vessel thrombosis in the setting of subarachnoid hemorrhage is unclear. Here we present a case of spontaneous posterior inferior cerebellar artery dissection presenting with subarachnoid hemorrhage and acute thrombosis. Although the patient was initially managed conservatively, angiographic follow-up demonstrated recanalization of the diseased vessel, necessitating definitive treatment. Thus we propose that angiographic follow-up is necessary in the management of patients with subarachnoid hemorrhage in association with apparent vessel thrombosis.

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“…Follow-up evaluation was achieved during a median period of 3 months (IQR 3-12 months) in 24 of the 28 patients (86%). The median value of the mRS score was 0 (IQR 0-1) [4,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21] . One case developed subsequent SAH, which was fatal [14] .…”

Section: Literature Reviewmentioning

confidence: 99%

Isolated Posterior Inferior Cerebellar Artery Dissection as a Cause of Ischemic Stroke: Clinical Features and Prognosis

Kobayashi¹,

Ohara²,

Shiozawa³

et al. 2015

Cerebrovasc Dis

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Background: The purpose of this study was to clarify the incidence, clinical and radiological features and outcomes of isolated posterior inferior cerebellar artery (PICA) dissection in isolated PICA territory infarctions. Methods: We retrospectively reviewed consecutive inpatients with ischemic stroke secondary to isolated PICA dissection from our stroke database between January 2004 and December 2013 and reviewed the literature with regard to those patients. Results: Of 167 consecutive patients with an isolated PICA territory infarction, a total of 10 patients (6.0%, 3 women, 48.1 ± 7.1 years) were diagnosed as having an isolated PICA dissection. Patients with PICA dissection were younger (p < 0.001), more commonly experienced headache at onset (p = 0.008), less commonly had hyperlipidemia (p = 0.044) and showed a lower modified Rankin Scale score at discharge (p = 0.002) when compared with patients without arterial dissection. In 6 of these 10 patients, PICA dissections had not been suspected on initial magnetic resonance angiography (MRA) and were confirmed by follow-up MRA or digital subtraction angiography. In the follow-up period (median 1.5 years, interquartile range 0.5-6.3 years), there were no recurrent ischemic or hemorrhagic stroke events. Conclusions: Isolated PICA dissection as an etiological mechanism in isolated PICA territory infarctions may be more common than was previously recognized to be. The diagnosis of PICA dissection is often difficult and requires close and repeated morphological evaluation. We should carefully identify PICA dissections as a possible cause of PICA territory infarctions.

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Do Characteristics of Dissection Differ between the Posterior Inferior Cerebellar Artery and the Vertebral Artery?

Cited by 23 publications

References 14 publications

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Subarachnoid hemorrhage then thrombosis of posterior inferior cerebellar artery dissection: is early surgical exploration warranted?

Isolated Posterior Inferior Cerebellar Artery Dissection as a Cause of Ischemic Stroke: Clinical Features and Prognosis

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