Posterior inferior cerebellar artery (PICA) infarct

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

4 days history of severe headaches, nausea and vertigo.

Patient Data

Age: 45 years
Gender: Male
This study is a stack
Sagittal
T1
This study is a stack
Coronal
T2
This study is a stack
Axial
FLAIR
This study is a stack
Axial
Gradient Echo
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
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Info

Large left cerebellar infarct involving the inferior posterior aspect of the cerebellum, the ipsilateral cerebellar tonsil and the lower part of the medulla oblongata (PICA territory). It appears as a large area of low signal on T1, high signal on FLAIR and T2 with restricted diffusion and no haemorrhagic component on the GE sequence. A mass effect is noted on the 4th ventricle.

Case Discussion

The clinical presentation and the MRI features are most consistent with a posterior inferior cerebellar artery (PICA) infarct.

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