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]

Clinical presentation and treatment of distal posterior inferior cerebellar artery aneurysm. Neurosurg Rev. 2011. 34: 57-67 [surgicalneurologyint.com]

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]

• Hunting

  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]

  Hunt-Hess (HH) grades were H-H Ⅰin 1 patient, H-H Ⅱ in 5 patients, H-H Ⅲ in 4 patients and H-H Ⅳ in 1 patient on admission. [ajol.info]

  His Hunt and Hess grade was grade III. Emergent ventricular drainage was performed for acute hydrocephalus. Figure 1 A diffusion-weighted image showing left brainstem infarction (a). [surgicalneurologyint.com]

  Endovascular surgery for proximal posterior inferior cerebellar artery aneurysms: an analysis of Glasgow Outcome Score by Hunt-Hess grades. Neurosurgery 2006;58:619–25 Sandalcioglu IE, Wanke I, Schoch B, et al. [ajnr.org]

• Decreased Sweating

  Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting Vestibular nucleus Horner’s syndrome (miosis, ptosis, decreased sweating) Descending sympathetic tract Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag reflex [minclinic.ru]

• 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]

  A, 3D right vertebral angiogram shows a wide-necked PICA aneurysm. This aneurysm was treated with coil occlusion, including the parent PICA (internal trapping). [ajnr.org]

  When facing wide neck aneurysms, SAC would be assisted with a stent by using semi-deploy technique. PAO was performed with coils, Onyx only or both coils and Onyx. [journals.lww.com]

  neck aneurysm at the telovelotonsillary segment. [kjronline.org]

• Meningism

  Arteries of the head and neck CC EC sup. thyroid superior laryngeal sternocleidomastoid branch infrahyoid branch cricothyroid branch glandular branches asc. pharyngeal posterior meningeal pharyngeal branches inferior tympanic lingual suprahyoid dorsal [ipfs.io]

  Inferior aspect (viewed from below). v t e Arteries of the head and neck CC EC sup. thyroid superior laryngeal sternocleidomastoid branch infrahyoid branch cricothyroid branch glandular branches asc. pharyngeal posterior meningeal pharyngeal branches [en.wikipedia.org]

  […] tympanic ) - accessory meningeal - inferior alveolar ( mylohyoid ) 2nd part: deep temporal - pterygoid branches - masseteric - buccal 3rd part: posterior superior alveolar - infraorbital ( anterior superior alveolar ) - descending palatine - artery of [psychology.wikia.com]

  […] posterior inferior) (superior) 433.8 cerebral (see also Thrombosis, brain) 434.0 choroidal (anterior) 433.8 communicating posterior 433.8 coronary (see also Infarct, myocardium) 410.9 extremities 444.22 femoral 444.22 hepatic 444.89 hypophyseal 433.8 meningeal [icd9data.com]

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]

Workup All patients presenting with scleritis should be worked up for associated systemic disease. [reviewofophthalmology.com]

Moreover, cardiac workup showed no evidence of intramural thrombus, endocarditis or atrial fibrillation in our patient. [cureus.com]

• Ischemic Changes

  Postoperative 3D CTA showed complete clipping of the aneurysm and no ischemic change, and his consciousness was better postoperatively than preoperatively. [surgicalneurologyint.com]

These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms. [neurologyindia.com]

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]

At that time, conservative medical treatment was performed though direct surgery, and endovascular treatment was considered. He was discharged after a month, with moderate right hemiparesis and mild dysarthria. [surgicalneurologyint.com]

prognosis. 10 Fig. 7 A Hamasaki/2014[62] 56/M 5 Proximal endovascular occlusion,. [medsci.org]

Older individuals and ones with a higher grade of severity when admitted have a higher chance of a poor prognosis. [brain-surgery.com]

Treatment and prognosis Treatment of posterior inferior cerebellar artery, and posterior circulation strokes in general, depends upon the nature, timing, and severity of symptoms. [radiopaedia.org]

Etiology Clinical features Clinical features Structure affected Ipsilateral Dysphagia Gag reflex Hoarseness, dysphonia Nucleus ambiguus (motor neuron) Ataxia, dysmetria, dysdiadochokinesia Inferior cerebellar peduncle Horner syndrome Uncontrollable hiccups [amboss.com]

The etiological cause was thought to be intracranial vertebral artery occlusion with a baseline insitu atherosclerosis, in the presence of branches having their origin from one side and going to both PICA territories. [dusunenadamdergisi.org]

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: Most commonly caused by atherothrombotic occlusion of the vertebral artery (then posterior inferior cerebellar arteray and least often the medullary arteries. [medicine.uiowa.edu]

These findings highlight that the cause of cerebral infarction can be related not only cerebral ischemia but also other etiologies. [ommegaonline.org]

Posterior Scleritis: Analysis of Epidemiology, Clinical Factors, and Risk of Recurrence in a Cohort of 114 Patients. Ocul Immunol Inflamm 2016;24:1: 6-15. 2. Auer, Herborn, Indocyanine green angiographic features in posterior scleritis. [reviewofophthalmology.com]

Epidemiology, Etiology & Prognosis A study reviewing 25 cases of Wallenberg Syndrome found the incidence to be highest in middle-aged men at 55.06 years of age[2]. [physio-pedia.com]

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]

Epidemiology, pathophysiology, diagnosis and management of intracranial artery dissection. Lancet Neurol. 2015;14:640–54. 5. Matsumoto J, et al. [bmcneurol.biomedcentral.com]

Metabolic syndrome: Definition, pathophysiology, and mechanisms. Am Heart J. 2005;149:33–45. [PubMed] [Google Scholar] 7. Olofsson SO, Wiklund O, Boren J. [ncbi.nlm.nih.gov]

Pathophysiology Atherosclerosis: the most common vascular disease affecting the vertebrobasilar system[1]: This affects large vessels, causing narrowing and occlusion. [patient.info]

Neck clipping was performed via a midline suboccipital approach in the prone position to prevent re-rupture 2 months after admission [ Figure 3 ]. [surgicalneurologyint.com]

See also the separate Stroke Prevention article. [patient.info]

We provide two case presentations where the outcome was predicted and certain morbidities prevented with the employment of a multimodal neuromonitoring paradigm. [cureus.com]

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]