Presentation
Headache, nystagmus, impaired coordination and vomiting.
Patient Data
CT non-contrast with stroke windowing (WW 40, WL 40) shows a subtle loss of grey white differentiation of the inferior cerebellar vermis and posterior inferior cerebellum. There is a small punctate hyperdensity along the course of the left PICA.
The left PICA loses contrast enhancement shortly after its origin. No distal branch enhancement. There is normal enhancement of the right PICA branches.
There is increased MTT at the left inferior cerebellum with corresponding less confluent decrease of CBV. indicating core infarct with small penumbra.
Case Discussion
This study shows the importance of checking every slice for abnormality as seen by the PICA infarct in the lowest slices.
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