Posterior inferior cerebellar artery (PICA) infarct

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Acute onset of vertigo, nausea and vomiting.

Patient Data

Age: 35 years
Gender: Male
This study is a stack
Sagittal
T1
This study is a stack
Axial
FLAIR
This study is a stack
Coronal
T2
This study is a stack
Axial
Gradient Echo
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
MRA
3D-TOF
This study is a stack
MRA
3D-TOF
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Info

There is a large left cerebellar infarct involving the posterior inferior cerebellar artery (PICA) territory seen as a large area of low signal on T1, high signal on T2 and FLAIR with restricted diffusion. A mass effect is noted on the 4th ventricle with moderate dilatation of the 3rd and lateral ventricles. On MRA 3D-TOF the right PICA is well-visualized arising from the vertebral artery while the left is not visualized.

Case Discussion

MRI appearances in keeping with an acute PICA territory infarct.

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