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Case Reports
. 2018 Aug;24(4):440-443.
doi: 10.1177/1591019918761640. Epub 2018 Mar 19.

Targeted endovascular treatment of haemorrhagic posterior fossa proliferative angiopathy

Suresh Giragani  1 , Santhosh Kumar Pavunesan  1 , Anandh Balasubramaniam  2
Affiliations
Case Reports

Targeted endovascular treatment of haemorrhagic posterior fossa proliferative angiopathy

Suresh Giragani et al. Interv Neuroradiol. 2018 Aug.

Abstract

Cerebral proliferative angiopathy (CPA) is a rare vascular abnormality and separate from "classical" brain arteriovenous malformations. Haemorrhage due to proliferative angiopathy is rarely reported. We describe the clinical features, imaging findings and targeted endovascular management for a 12-year-old boy having proliferative angiopathy of the posterior fossa presenting with haemorrhage. Targeted endovascular embolisation in CPA is not previously described in the literature. The optimal treatment options for haemorrhagic CPA are debatable, and we wish to highlight the role of targeted treatment for culprit focal lesion demonstrable on imaging.

Keywords: Aneurysm; angiography; arteriovenous malformation; embolisation; posterior fossa haemorrhage.

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Figures

Figure 1.
Figure 1.
Non-contrast axial computed tomography image (a) showing intraparenchymal haemorrhage in cerebellar hemisphere and cerebellar vermis extending into the fourth ventricle. Cerebral angiography arterial and capillary phase images ((b) and (c)) showing ill-defined diffuse nidus in posterior fossa fed by arteries of posterior circulation with early draining veins as well as right distal anterior inferior cerebellar artery (AICA) aneurysm. Intraprocedural XperCT axial contrast image depicting the aneurysm (d) and the superselective microcatheter injection (e) of the right distal AICA showing the aneurysm and arteriovenous fistula.
Figure 2.
Figure 2.
Left vertebral artery check angiogram (a) after Onyx embolisation demonstrating complete obliteration of the aneurysm and arteriovenous fistula of the right distal anterior inferior cerebellar artery (AICA). Intraprocedural XperCT image (b) showing Onyx cast of the right AICA. Follow-up magnetic resonance imaging (MRI), axial susceptibility weighted image (c) showing the focal area of blooming corresponding to thrombosed right AICA aneurysm and MR angiogram coronal maximum intensity projection image (d) showing patent proximal segment of right AICA.
See this image and copyright information in PMC

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