ABSTRACT
We report a case of vertebral artery (VA) dissection presenting with repeated distal embolism. A 48-year-old man was admitted to our institution with neck pain and vertigo of two day duration. MRI on arrival showed infarction of the left cerebellar hemisphere and the right occipital lobe. Emergency angiography revealed left VA dissection and occlusion of the left posterior inferior cerebellar artery and right calcaline artery. Six hours after admission, he manifested cortical blindness due to embolism of the contralateral left calcaline artery despite giving heparin and aspirin. Thrombolysis was performed but was not successful. We embolized the affected VA to prevent further embolism. We discuss here the indication and timing of treatment for VA dissection presenting with ischemic symptom.
Subject(s)
Intracranial Thrombosis/etiology , Vertebral Artery Dissection/complications , Blindness, Cortical/etiology , Cerebellum/blood supply , Cerebral Angiography , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/etiology , Humans , Intracranial Thrombosis/diagnostic imaging , Male , Middle Aged , Recurrence , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/surgeryABSTRACT
A case with arteriovenous malformation (AVM) associated with moyamoya phenomenon is reported. The 44 year-old female patient was presented with headache and vomiting. Computed tomography (CT) scan showed intraventricular hemorrhage. Cerebral angiography showed right frontal AVM and severe stenosis of right internal carotid artery. The AVM was fed by typical moyamoya vessels, Heubner's artery, and external carotid artery (ECA). We tried to embolize a bleeding point, compartment attached to lateral ventricle, but we could not. So, we embolized feeders from ECA and sent the patient to radiosurgery. We discuss here treatment and etiology of such rare condition.
