Morishita Masahiro, Shindo Koichiro, Yoshihara Ryunosuke, Ishikawa Kohei, Nomura Ryota, Endo Hideki, Oka Koji, Nakamura Hirohiko
Department of Neurosurgery, Nakamura Memorial South Hospital, 2-3-1 Kawazoe 2-jo, Minami-ku, Sapporo, Hokkaido 005-8555, Japan.
Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
Radiol Case Rep. 2023 Feb 27;18(5):1686-1690. doi: 10.1016/j.radcr.2023.01.099. eCollection 2023 May.
Intracranial artery dissection accounts for a small percentage (1%-2%) of all ischemic strokes. Vertebral artery dissection sometimes extends to the basilar artery but very rarely to the posterior cerebral artery. We report a case of bilateral vertebral artery dissection extending to the left posterior cerebral artery with the characteristic distribution of intramural hematoma. A 51-year-old woman presented with right hemiparesis and dysarthria 3 days after sudden neck pain. Magnetic resonance imaging on admission revealed infarcts in the left thalamus and temporo-occipital lobe and findings suggestive of bilateral vertebral artery dissection. No infarct was detected in the brainstem. The patient was treated conservatively. Initially, we suspected that infarction in the left posterior cerebral artery territory had been caused by artery-to-artery embolism from the dissected vertebral arteries. However, T1-weighted imaging on day 15 of admission revealed intramural hematoma extending from the left vertebral artery to the left posterior cerebral artery. Therefore, we diagnosed bilateral vertebral artery dissection extending to the basilar artery and the left posterior cerebral artery. The patient's symptoms subsequently improved with conservative treatment, and she was discharged with a modified Rankin Scale score of 1 on day 62 of admission. In this case, intramural hematoma of the basilar artery was found in the anterior vessel wall. Brainstem infarction is less likely when intramural hematoma is located in the anterior vessel wall of the basilar artery in vertebrobasilar artery dissection. T1-weighted imaging is useful for the diagnosis of this rare condition and can predict potentially impaired branches and possible symptoms.
颅内动脉夹层在所有缺血性卒中中占比很小（1%-2%）。椎动脉夹层有时会延伸至基底动脉，但极少延伸至大脑后动脉。我们报告一例双侧椎动脉夹层延伸至左侧大脑后动脉并伴有壁内血肿特征性分布的病例。一名51岁女性在突发颈部疼痛3天后出现右侧偏瘫和构音障碍。入院时的磁共振成像显示左侧丘脑和颞枕叶梗死，提示双侧椎动脉夹层。脑干未检测到梗死灶。患者接受保守治疗。最初，我们怀疑左侧大脑后动脉区域的梗死是由夹层椎动脉的动脉到动脉栓塞引起的。然而，入院第15天的T1加权成像显示壁内血肿从左侧椎动脉延伸至左侧大脑后动脉。因此，我们诊断为双侧椎动脉夹层延伸至基底动脉和左侧大脑后动脉。患者的症状随后经保守治疗得到改善，入院第62天出院时改良Rankin量表评分为1分。在该病例中，基底动脉壁内血肿位于血管前壁。在椎基底动脉夹层中，当壁内血肿位于基底动脉前壁时，脑干梗死的可能性较小。T1加权成像对诊断这种罕见疾病有用，并且可以预测潜在受损的分支和可能出现的症状。
