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Case Reports
. 2020;14(10):428-434.
doi: 10.5797/jnet.cr.2019-0117. Epub 2020 Jul 22.

A Case of Brainstem Infarction That Was Found to Be Vertebral Artery Dissection in a Short Period after the Diagnosis of Atherothrombotic Infarction

Hisanori Edaki  1 , Hisakazu Itami  1 , Kenta Ikushima  1 , Yukei Shinji  1 , Shinji Otsuka  1 , Noboru Kusaka  1 , Tsukasa Nishiura  1 , Kotaro Ogihara  1
Affiliations
Case Reports

A Case of Brainstem Infarction That Was Found to Be Vertebral Artery Dissection in a Short Period after the Diagnosis of Atherothrombotic Infarction

Hisanori Edaki et al. J Neuroendovasc Ther. 2020.

Abstract

Objective: We report a case of vertebral artery dissecting aneurysm that caused right lateral medullary infarction, which was treated by endovascular therapy.

Case presentations: A 57-year-old man developed right-side headache and dysarthria on the day before presentation, and exhibited mouth dropping and dysphagia the following day. Initial MRI demonstrated right lateral medullary infarction with atherothrombotic change with no vessel lesion, and we started infusion and medication administration. Later MRI revealed bilateral vertebral artery dissection, and we treated the growing right vertebral artery dissecting aneurysm by stenting and coils.

Conclusion: The possibility of dissecting lesions should be considered in cases of medullary infarction. Stenting and coil treatment is a useful option for bilateral dissecting vertebral aneurysms.

Keywords: brain stem infarction; stent and coil; vertebral artery dissecting aneurysm.

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Conflict of interest statement

We declare no conflicts of interest during the past 3 years.

Figures

Fig. 1
Fig. 1. MRI on the initial consultation. (A) DWI revealed an infarcted focus on the lateral side of the right medulla oblongata (solid arrow). (B) MRA showed no wall irregularity in the left or right vertebral arteries. DWI: diffusion-weighted imaging
Fig. 2
Fig. 2. MRI (A and B) and CT (C and D) on Day 12. (A and C) Lateral view showing a dissecting right vertebral artery aneurysm (3 × 4 mm) and narrowing (pearl and string sign) (solid arrows). (B and D) Frontal view showing a dissecting right vertebral artery aneurysm (solid arrows) and wall irregularity in the left vertebral artery (dotted arrows).
Fig. 3
Fig. 3. MRI (A and B) and CT (C and D) on Day 19. (A) The size of the dissecting right vertebral artery aneurysm had increased to 3.5 × 4.5 mm (solid arrow). (B) Enlargement of the dissecting right vertebral artery aneurysm (solid arrow) was noted, whereas there was no change in wall irregularity in the left vertebral artery (dotted arrow). (C and D) Bleb formation was observed in the dissecting right vertebral artery aneurysm site (solid arrow).
Fig. 4
Fig. 4. Right vertebral arteriography on Day 22. (A and B) The PICA (dotted arrows) was observed at an area proximal to the aneurysm (solid arrows) with a sufficient distance. PICA: posterior inferior cerebellar artery
Fig. 5
Fig. 5. DSA at the time of treatment on Day 25. (A) An LVIS Jr 3.5 × 23 mm was deployed such that its distal and proximal ends reached an area before the union and beyond the origin of the PICA (solid arrow), respectively. (B) Immediately after stenting, there was a delay in intra-aneurysmal blood flow (dashed arrow). (C and D) Immediately after coil embolization. There was no intra-aneurysmal blood flow (dotted arrows) and the PICA remained (solid arrows). PICA: posterior inferior cerebellar artery
Fig. 6
Fig. 6. MRI on Day 26. (A) The dissecting right vertebral artery aneurysm was not visualized (solid arrow). (B) The dissecting right vertebral artery aneurysm was not visualized (solid arrow). There was no progression of wall irregularity in the left vertebral artery (dotted arrow).
See this image and copyright information in PMC

References

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