Massive cerebellar infarction caused by spontaneously isolated posterior inferior cerebellar artery dissection: A case report

Table 1 Clinical and imaging characteristics, diagnostic methods, treatment, and outcomes of stroke caused by posterior inferior cerebellar artery dissection

Patient	Age (years) and sex	Predisposing causes and main symptoms	Methods of diagnostic imaging	Types of stroke caused by PICAD	Main treatment	Outcome and follow-up
Patient 1[2]	40-year-old woman	Sudden headache during sexual intercourse, followed by a loss of consciousness	DSA revealed right PICAD	CT showed SAH	Endovascular treatment	No neurological symptoms at discharge; 3-year DSA showed complete occlusion of the AD
Patient 2[2]	66-year-old man	History of hypertension and development of a severe headache accompanied by vomiting and confusion	DSA demonstrated right PICAD	CT showed diffuse SAH with ventricular enlargement	Injection of a mixture of histoacryl and lipiodol	Neurological examination 3 years later was normal, and DSA showed that the AD was completely occluded
Patient 3[2]	46-year-old woman	Vertigo and diplopia after a cervical manipulation, followed by a headache with nuchal rigidity	DSA showed right PICAD	CT and MRI revealed an SAH with cerebral ischemia in the territory of the PICA	Non-surgical treatment	Diplopia at discharge. DSA at 4 months displayed unchanged PICAD. No further symptoms observed at the 2-year follow-up
Patient 4[2]	71-year-old woman	Sudden unconsciousness	DSA revealed left PICAD	CT showed SAH and intraventricular hemorrhage	Occlusion of the pseudoaneurysm was performed with coils	Intense weakness, diplopia, and cognitive impairment 3 years after therapy
Patient 5[2]	42-year-old woman	Intense posterior headache, dizziness, and vomiting after cervical manipulation	DSA revealed right PICAD	CT revealed right cerebellar infarction	Intravenous heparin for 2 weeks	Clinical state improved considerably. The patient was free of symptoms after 2 years
Patient 6[8]	63-year-old man	Severe acute occipital headaches and vomiting	DSA revealed left PICAD	CT showed a massive SAH in the posterior fossa	Aneurysmorrhaphy and a wrapping procedure	Symptoms resolved after surgery
Patient 7[8]	28-year-old man	Sudden onset of vertigo and numbness of the left hemiface	DSA revealed left PICAD	Not mentioned	Conservative treatment, followed by endovascular treatment	Freedom from neurological symptoms at the 5-month follow up
Patient 8[8]	33-year -old woman	Sudden severe headaches after transient unconsciousness	DSA showed a left PICAD	CT revealed SAH	PICAD was trapped and resected	At 5 months, neurological examination revealed slightly weak voice
Patient 9[9]	48-year-old man	Severe, throbbing headache	MRI revealed a right PICAD	No infarctions or hemorrhages	Conservative therapy	Headache rapidly improved. MRI showed almost-resolved PICAD 4 months later
Patient 10[10]	52-year-old woman	Nausea, vomiting, vertigo, gait instability, and headaches for 1 day	CTA showed focal stenosis in the left PICAD	CT and MRI showed an extensive left cerebellar hemisphere infarct	Aspirin, statin, and antihypertensive medication	Full recovery within 3 months; 7-, 12- and 18- month CTA showed the beaded appearance of the left PICA
Patient 11[10]	60-year-old woman	Acute headaches, nausea, vomiting, loss of consciousness, and seizure	CTA and DSA showed a left PICAD	CT revealed SAH, intraventricular hemorrhage, and hydrocephalus	Endovascular treatment for PICAD	1-year follow-up CTA showed minimal decrease in size of PICAD, accompanied by mild cognitive impairment
Patient 12[11]	41-year-old man	Mild left occipital headache, followed by dizziness, nausea, and vomiting	DSA detected a PICAD	MRI revealed infarction in the left cerebellar hemisphere	Intravenous edaravone and oral ibudilast	10-week follow-up MRA indicated resolution of the PICAD, and symptoms improved

AD: Dissecting aneurysm; CT: Computed tomography; CTA: Computed tomographic angiography; DSA: Digital subtraction angiography; MRI: Magnetic resonance imaging; MRA: Magnetic resonance angiography; PICA: Posteroinferior cerebellar artery; PICAD: Posteroinferior cerebellar artery dissection; SAH: Subarachnoid hemorrhage.