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Posterior inferior cerebellar artery occlusion


Presentation

  • A 28-year-old man presented with acute severe headache and vomiting followed by seizure. At admission, he was drowsy, with diplopia and right ankle hypesthesia. Computed tomographic scans demonstrated a subarachnoid hemorrhage.[jkns.or.kr]
  • Naito I, Iwai T, Sasaki T (2002) Management of intracranial cerebral artery dissection initially presenting without subarachnoid hemorrhage. Neurosurgery 51:930–938 PubMed Google Scholar 7.[link.springer.com]
  • Case presentation We report the case of a 74-year-old Italian woman who presented with a complaint of dizziness.[paperity.org]
  • Clinical presentation Vertigo, nausea and truncal ataxia are the most common presenting features. Signs of a lateral medullary syndrome may coexist in 30% 2 .[radiopaedia.org]
  • II, 10.7% presented as Hunt-Hess grade III, 4.9% presented as Hunt-Hess grade IV, and 2.4% presented as Hunt-Hess grade V.[neupsykey.com]
Cough
  • Treatments for respiratory complications: Assess respiratory drive, gag reflex, cough reflex (to expel secretions). Consider endotracheal intubation (Glasgow Coma Scale less than 8).[patient.info]
Wide Neck
  • Siddiqui MA, Bhattacharya JJ, Lindsay KW, Jenkins S (2009) Horizontal stent-assisted coil embolization of wide-necked intracranial aneurysms with the Enterprise stent – a case series with early angiographic follow-up.[link.springer.com]
  • […] cranial nerves (CNs), and the variation of location. 3, 4, 9, 21, 24 In addition, these aneurysms may cause mass effects such as lower CN palsy, rupture at a small size, have a greater rate of rebleeding, and a high proportion of fusiform, dissecting, or wide-neck[neurosurgerycns.wordpress.com]
  • neck aneurysm at the telovelotonsillary segment.[kjronline.org]
  • View Article PubMed Google Scholar Tähtinen OI, Vanninen RL, Manninen HI, Rautio R, Haapanen A, Niskakangas T, Rinne J, Keski-Nisula L: Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute ( View Article PubMed[jmedicalcasereports.biomedcentral.com]
Excitement
  • * Super super excited to share this mnemonic with you * __ But let's get to the basics first! What is lateral medullary syndrome? Neurological symptoms due to injury to lateral part of the medulla. Also called Wallenberg's syndrome.[medicowesome.com]
  • Rotational vertebral artery occlusion syndrome with vertigo due to “labyrinthine excitation”. Neurology. 2000;54(6):1376–1379. pmid:10746615 View Article PubMed/NCBI Google Scholar 19. Noh Y, Kwon OK, Kim HJ, Kim JS.[journals.plos.org]
Seizure
  • A 28-year-old man presented with acute severe headache and vomiting followed by seizure. At admission, he was drowsy, with diplopia and right ankle hypesthesia. Computed tomographic scans demonstrated a subarachnoid hemorrhage.[jkns.or.kr]
  • Case Report A 52-year-old woman presented with a history of sudden onset of severe headache and vomiting with a negative history of loss of consciousness and seizure.[asianjns.org]
Agitation
  • The presentation in these patients varies from lethargic to obtunded to comatose, but some patients may be agitated and may have associated hemiplegia or hemisensory loss.[emedicine.medscape.com]
  • Sedation and muscle relaxation may be needed if agitated or resisting mechanical ventilation but these will have to be reversed before a full neurological assessment can be carried out.[patient.info]
Convulsions
  • […] directly into the brain, it may cause irreparable damage to the brain and this condition is known as a “haemorrhagic stroke” causing: debilitation or partial/complete paralysis of a limb difficulty in speaking or comprehending language difficulty in seeing convulsions[brain-surgery.com]
Hypesthesia
  • At admission, he was drowsy, with diplopia and right ankle hypesthesia. Computed tomographic scans demonstrated a subarachnoid hemorrhage. Cerebral angiography demonstrated a dissecting aneurysm of the left proximal PICA.[jkns.or.kr]

Workup

  • Workup did not show evidence for cardioembolic or atheroembolic source. The presence of an extradural origin of PICA may be considered a predisposing factor for non-traumatic LMS associated with head and neck movement.[link.springer.com]

Treatment

  • Steve Roach, Kerstin Bettermann, and José Biller have completely revised and updated sixth edition of the highly respected standard for stroke diagnosis and treatment, adding chapters on genetics, pregnancy-related stroke, and acute treatment.[books.google.com]
  • Article Access Statistics Viewed 2349 Printed 51 Emailed 0 PDF Downloaded 56 Comments 2 Use of a Polytetrafluoroethylene-Coated Vascular Plug for Focal Intracranial Parent Vessel Sacrifice for Fusiform Aneurysm Treatment Andrew P Carlson,Mohammad Abbas[neurologyindia.com]
  • The decision that led to the choice of treatment is discussed. Key Words: PICA ; Dissecting aneurysm ; Endovascular technique[jkns.or.kr]
  • Shin YS, Kim HS, Kim SY (2007) Stenting for vertebrobasilar dissection: a possible treatment option for nonhemorrhagic vertebrobasilar dissection. Neuroradiology 49:149–156 PubMed CrossRef Google Scholar 11.[link.springer.com]
  • Endovascular treatment of ruptured distal posterior inferior cerebellar artery aneurysms:report of 11 cases Abstract Objective: To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery[ajol.info]

Prognosis

  • Older individuals and ones with a higher grade of severity when admitted have a higher chance of a poor prognosis.[brain-surgery.com]
  • Prognosis is generally quite good with full or near full recovery expected at 6 months. Diagnosis is generally via MRI (see below). CT-angiography with 3D reconstruction has gotten good enough in recent years to be helpful too.[dizziness-and-balance.com]
  • Prognosis is generally quite good with full or near full recovery expected at 6 months. Diagnosis is generally via MRI.[tchain.com]
  • The prognosis for the majority is good, with a large measure of functional independence. Wallenberg painted a distinctive picture, which has not been bettered after 100 years.[jnnp.bmj.com]

Etiology

  • It is important to contrast these clinical manifestations with those involving strokes of the anterior circulation, as the etiology and treatment may differ.[casemed.case.edu]
  • Etiology Clinical features Clinical features Structure affected Ipsilateral Dysphagia Gag reflex Hoarseness, dysphonia Nucleus ambiguus motoric nucleus Ataxia, dysmetria, dysdiadochokinesia Inferior cerebellar peduncle Horner syndrome Uncontrollable hiccups[amboss.com]
  • These findings highlight that the cause of cerebral infarction can be related not only cerebral ischemia but also other etiologies.[ommegaonline.org]
  • […] normal post-surgical angiographic reports of the aorta and arteries in the regions of the skull and kidney, the absence of any particular concerns being revealed in echocardiography, as well as normal CT scans of the abdomen excluded any of these as etiologies[brain-surgery.com]
  • MRI is frequently needed to make a specific diagnosis and to separate vascular etiologies from tumor and other structural injuries. The pattern of sensory disturbance may be helpful.[tchain.com]

Epidemiology

  • Epidemiology Typically considered the most common territory involved in cerebellar infarction , although at least one study 1 has demonstrated similar frequencies of PICA and SCA infarcts.[radiopaedia.org]
  • Epidemiology A relatively uncommon form of stroke.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • In Barnet HJM (and others, Eds), Stroke: Pathophysiology, Diagnosis and Management. New York: Chrchill-Livingstone, pp 549-619, 1986 Faught E, Oh SJ. Brainstem auditory responses in brainstem infarction.[dizziness-and-balance.com]
  • Palinopsia, micropsia, and macropsia These are illusory phenomena that are of uncertain pathophysiology. Palinopsia describes the persistence of a visual image for several seconds to days in a partially blind hemifield.[emedicine.medscape.com]
  • Pathophysiology Atherosclerosis : the most common vascular disease affecting the vertebrobasilar system: [ 1 ] This affects large vessels, causing narrowing and occlusion.[patient.info]

Prevention

  • Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia.[patient.info]
  • Conclusions: Coiling of ruptured distal PICA aneury, with or without parent vessel occlusion, was feasible, relatively safe and effective in preventing early/medium-term rebleeding.[ajol.info]
  • However, in some patients, adequate collateral circulation prevents infarction in the territory of the occluded vessel. [9] The best way to test the safety of parent vessel occlusion is to perform a temporary balloon test occlusion, but this is impossible[asianjns.org]
  • In his case study, he emphasized a left occipital cortex lesion and also infarction of the splenium of the corpus callosum, which disconnected fibers from the right occipital lobe, preventing them from reaching the angular gyrus.[emedicine.medscape.com]
  • In fact, sometimes preventing a second stroke, by modifying risk factors, is unfortunately all that can be done for some patients. Top Overview Lateral medulla strokes give rise to a constellation of signs and symptoms known as Wallenberg syndrome.[virtualmedstudent.com]

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