Presentation
Suspected cerebral infarction.
Patient Data
No evidence of recent infarction or hemorrhage (CT brain not shown).
Incidentally noted absence of right posterior inferior cerebellar artery (PICA). Well-developed left PICA.
Case Discussion
Unilateral absence of the PICA is common 1,2. The differential diagnosis for an absent PICA is PICA occlusion and a hypoplastic PICA. In this specific case, there was no clinical suspicion nor imaging evidence of a PICA territory cerebellar infarction (PICA occlusion), nor was there any sign of origin of the artery (hypoplastic PICA). A sign that strengthens the diagnosis of an absent PICA is the well-developed contralateral PICA 1. If the rest of the PICA's course is visible (see PICA -Segments), look for an anomalous origin - it may originate from the basilar artery 2.
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