Presentation
Two days vertigo, now right facial droop, right arm and leg weakness, and dysarthria.
Patient Data
There is a left pontine heterogenous hypoattenuation with subtle mass effect which is suggestive of an acute pontine infarction.
Otherwise, gray white matter differentiation is well preserved, and there is no hyperdense vessel. Skull, orbits and sinuses unremarkable.
FLAIR hyperintensity and diffusion restriction on the left side of the pons are consistent with a recent infarct.
The diffusion sequence shows three tiny foci of high signal in the right cerebellar hemisphere and a further focus at the ponto-medullary junction on the right side. Three of these show high
FLAIR signal, though one of the cerebellar foci is not visible. These foci are difficult to see on the ADC map, but there is the impression of true diffusion restriction.
The ventricular size and sulcal pattern are age-appropriate. There is no hydrocephalus. No abnormal magnetic susceptibility is appreciated.
Case Discussion
Angiography (not shown) demonstrated a right-sided vertebral artery dissection.