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Case Reports
. 2014 May 9;1(1):9-11.
doi: 10.2176/nmccrj.2013-0276. eCollection 2014 Oct.

Pathological Considerations for Unruptured Dissecting Aneurysm in the Posterior Inferior Cerebellar Artery: Case Report

Michiyuki Miyamoto  1   2 , Naoki Nakayama  2 , Masaaki Hokari  2 , Satoshi Kuroda  2 , Shugo Takikawa  1 , Kiyohiro Houkin  2
Affiliations
Case Reports

Pathological Considerations for Unruptured Dissecting Aneurysm in the Posterior Inferior Cerebellar Artery: Case Report

Michiyuki Miyamoto et al. NMC Case Rep J. .

Abstract

Because of the wide spread of magnetic resonance image (MRI), it may be increasing to find a dissecting aneurysm (DA) of the posterior inferior cerebellar artery (PICA) that causes headache without associated hemorrhage or infarction. Generally, surgical treatment might be considered in cases of DA with hemorrhage. However, the treatment of an unruptured DA with headache or infarction has not been well established. This is the first report regarding the pathology of an intact DA of the PICA that presents with headache only, and the pathological findings showed interesting figures. A 44-year-old man with an unruptured DA of the left PICA presented with sudden left occipital headache. MRI revealed no hemorrhage or infarction. Magnetic resonance angiography (MRA) showed growth of the DA 12 days after the onset of headache. Therefore, surgery was performed to prevent aneurysmal rupture. This DA aneurysm was trapped and removed after an occipital artery (OA)-PICA anastomosis was performed. The surgery was performed without complication. Pathological findings showed folding of the internal elastic lamina, and the true lumen was torn by the false lumen. The dissection reached the adventitia and the wall had numerous macrophages. Pathological findings might help understanding the etiology of DAs and inflammation might play an important role in DAs.

Keywords: headache; pathology; posterior inferior cerebellar artery; unruptured dissecting aneurysm.

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Conflict of interest statement

Conflicts of Interest Disclosure None to be declared. Author declared COI in the Japan Neurosurgical Society.

Figures

Fig. 1
Fig. 1
Fluid-attenuated inversion recovery (A) and diffusion weighted magnetic resonance image (B) show no hemorrhage or infarction in this patient. MRA (C) and DSA (D) show unruptured dissecting aneurysm in the posterior inferior cerebellar artery 7 days post onset of headache. Follow-up MRA (E) and DSA (F) show growth of the aneurysm 12 days post onset of headache. MRA: magnetic resonance angiography, DSA: digital subtraction angiography.
Fig. 2
Fig. 2
A: The aneurysmal wall was red and thin. B: The aneurysm had thrombus present. C: Postoperative magnetic resonance image shows no infarct lesion. D: Magnetic resonance angiography shows flow of the occipital artery-posterior inferior cerebellar artery anastomosis.
Fig. 3
Fig. 3
A, B: Hematoxylin eosin staining. C–E: Elastica van gieson staining. Pathological finding (E) shows folds of the internal elastic lamina and collapses the true lumen. Furthermore, smooth muscle was missing, and the dissection reached the adventitia (B and D). F: CD68 staining shows the aneurysmal wall had numerous macrophages. Scale bars = 250 μm.
See this image and copyright information in PMC

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