Hyperdense vessel sign (right vertebral artery)

Case contributed by Sachi Hapugoda


Fall with headstrike 3 days ago. Nausea, vomiting and vertigo.

Patient Data

Age: 90 years
Gender: Male

Wedge-shaped hypoattenuation in the inferior aspect of the right cerebellar hemisphere with loss of grey-white matter differentiation, consistent with a PICA territory infarct. Dense vessel sign in the right vertebral artery at the foramen magnum. No tonsillar herniation or fourth ventricular effacement.

Occlusion throughout the partially imaged cervical and intracranial portions of the right vertebral artery with a small amount filling distally. No right PICA opacification.

The imaged left vertebral artery and basilar arteries are patent. The circle of Willis and major branches are otherwise patent. Incidental ACA trifurcation (normal variant).

Confirmed acute right cerebellar hemisphere infarct in the PICA territory. Additional acute infarct focus in the left corona radiata.

Case Discussion

A case of a hyperdense vertebral artery sign, found on investigation of head injury after a fall, which was likely secondary to the acute right PICA territory infarct.

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