A Case of Lateral Medullary Infarction after Endovascular Trapping of the Vertebral Artery Dissecting Aneurysm

Abstract

We report an unusual case of lateral medullary infarction after successful embolization of the vertebral artery dissecting aneurysm (VADA). A 49-year-old man who had no noteworthy previous medical history was admitted to our hospital with a severe headache. Computed tomography (CT) revealed a subarachnoid hemorrhage, located in the basal cistern and posterior fossa. Cerebral angiography showed a VADA, that did not involve the origin of the posterior inferior cerebellar artery (PICA). We treated this aneurysm via endovascular trapping of the vertebral artery distal to the PICA. After operation, CT revealed post-hemorrhagic hydrocephalus, which we resolved with a permanent ventriculoperitoneal shunt procedure. Postoperatively, the patient experienced transient mild hoarsness and dysphagia. Magnetic resonance image (MRI) showed a small infarction in the right side of the medulla. The patient recovered well, though he still had some residual symptom of dysphagia at discharge. Such an event is uncommon but can be a major clinical concern. Further investigation to reveal risk factors and/or causative mechanisms for the medullary infarction after successful endovascular trapping of the VADA are sorely needed, to minimize such a complication.

A Case of Lateral Medullary Artery Arisen from the Posterior Meningeal Artery

“…1) Furthermore, a lateral medulla-penetrating vessel branches from the VA trunk or PICA. [4][5][6] In the present case, 3D angiography showed a lateral medulla-penetrating vessel branching from the PMA. Furthermore, lateral medullary infarction, which may have been related to occlusion of this blood vessel, occurred.…”

Patients with subarachnoid haemorrhage from vertebrobasilar dissection: treatment with stent-in-stent technique

“…An axial T2-weighted image taken from an MRI scan performed 3 weeks after the initial haemorrhage showed no signs of perforator infarction (d) [29] can help to guide the potential risks of different operative strategies. Cases of lateral medullary syndrome, secondary to trapping for vertebral dissection, have been reported [30]. Furthermore, there are cases of re-canalisation, of both the parent vessel and the aneurysm, following trapping [31][32][33].…”

A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation

“…As a result, blood flow is stopped and thrombosis or distal embolism of the dissection site appears. 3 10) Focal ischemia occurs several hours or weeks after such a dissection, which occurs either because blood flow is reduced from the arterial blood supply or because the risk of thrombosis and embolism is increased due to the turbulence and irregularities in the vessel wall at the dissected location. 2 4) …”

“…The treatment for this is anticoagulant or antiplatelet therapy. 3 10) Surgical intervention only applies to patients with persistent and fatal symptoms that are untreatable. Intravascular therapy, including balloon angioplasty and stenting, may be used as an initial treatment only if pharmacological treatment fails.…”

“…Intravascular therapy, including balloon angioplasty and stenting, may be used as an initial treatment only if pharmacological treatment fails. 3 10) …”