title: Spontaneous isolated posterior inferior cerebellar artery dissection: rare but underdiagnosed cause of ischemic stroke.
abstract: BACKGROUND
  Spontaneous isolated posterior inferior cerebellar artery dissection (PICAD) is a very rare cause of ischemic stroke. Clinical and radiologic features of ischemic type of isolated spontaneous PICAD are not well established.
  
  
  METHODS
  We consecutively enrolled patients who had spontaneous isolated PICAD confirmed by digital subtraction cerebral angiography. Clinical manifestation, magnetic resonance imaging (MRI), and angiography were analyzed.
  
  
  RESULTS
  Seven patients were diagnosed as ischemic type of spontaneous isolated PICAD. Patients experienced an occipital headache, followed by vertigo, postural imbalance, or Wallenberg syndrome. Six showed medullar, unilateral, or bilateral cerebellar infarctions on diffusion-weighted imaging (DWI). One presented with transient cerebellar ischemia and negative on DWI. T1-weighted imaging showed high signal intensity in posterior inferior cerebellar artery in only 1 patient. Susceptibility-weighted imaging (SWI) revealed hypointense signal with blooming effect in posterior inferior cerebellar artery in 5 patients. The modified Rankin Scale score at 3 months was 0 or 1 in all patients.
  
  
  CONCLUSIONS
  Clinical manifestations in ischemic type of spontaneous isolated PICAD were similar to those of intracranial vertebral artery dissection. Clinical course was relatively stable and benign. SWI was more helpful to suspect abnormality of posterior inferior cerebellar artery than conventional MRI or magnetic resonance angiography in our small series. Cerebral angiography is recommended in patients with clinically suspected spontaneous isolated PICAD for definite diagnosis.
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
authors.forename: Min-Gyu
authors.initials: MG
authors.lastname: Park
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Neurology, Dong-Eui Medical Center, Busan, Republic of Korea.
authors.forename: Tae-Il
authors.initials: TI
authors.lastname: Yang
authors.affiliation: Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea.
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Oh
authors.affiliation: Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
authors.forename: Seung Kug
authors.initials: SK
authors.lastname: Baik
authors.affiliation: Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea. Electronic address: kppark@pusan.ac.kr.
authors.forename: Kyung-Pil
authors.initials: KP
authors.lastname: Park
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology*; D002526:Cerebellar Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Posterior inferior cerebellar artery; dissection; ischemic stroke; susceptibility-weighted image