Presentation
Sudden collapse with right sided headache while doing sports activities. Right neck pain last night.
Patient Data
No acute intracranial hemorrhage or established acute cortical infarct. Grey-white differentiation is maintained.
There is a dissection of the right vertebral artery from the V2 segment at the C2-3 level, extending into the V3 and V4 segments. The distal-most segment of the right V4 vertebral artery backfills from the left vertebral artery. There is a filling defect in the tip of the basilar artery, extending into the proximal P1 segment of the right posterior cerebral artery. The posterior cerebral artery distal to this opacifies normally, with some supply being derived from the right foetal PCOM. Normal opacification of the left PCA. The remainder of the intracranial circulation opacifies normally, with no filling defects, stenoses or vascular malformations.
There is an established infarct involving the superior aspects of the right cerebellar hemisphere and lateral pons. Note the occlusion and absence of flow void within the imaged distal V4 segment od the right vertebral artery.
Case Discussion
This case demonstrates a spontaneous right sided distal vertebral artery dissection evolving to complete occlusion of the segment and posterior fossa infarcts.
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