Intraoperative Visualization of Bilateral Thrombosis in the Posterior Inferior Cerebellar Artery Apparent in the Telovelomedullary Segment

Abstract

Unilateral posterior inferior cerebellar artery (PICA) thrombosis is frequent. However, bilateral PICA thrombosis is rare. Herein we report about an intraoperative visualization of a bilateral thrombosis of the telovelomedullary segment of the PICA. A 74-year-old woman was admitted to our department on day two of a bilateral PICA thrombosis with developing cerebellar infarction. Her Glasgow Coma Scale score dropped from 15 to 13, and cranial computed tomography revealed compression of the fourth ventricle with consecutive occlusive hydrocephalus. After the insertion of an external ventricular drainage, the patient underwent urgent suboccipital decompressive craniectomy with removal of infarcted cerebellar tonsils, which allowed the bilateral visualization of the thrombosed telovelomedullary segments. The surgical access may offer surgical therapeutic options in a hyperacute occlusion, such as thromb-/embolectomy or bypass procedures.

TRP Channels Role in Pain Associated With Neurodegenerative Diseases

“…In addition, calcium flow from the endoplasmatic reticulum (ER) is highly regulated by Ryanodine receptors, Inositol trisphosphate receptor, calciumdependent kinases, and phosphatases (Brini et al, 2014). Alterations in Ca 2 + homeostasis have been related to the appearance and progression of several NDDs, including AD and PD (Marambaud et al, 2009;Nevzati et al, 2014). Indeed, it has been reported that exposure to either Aβ peptides (Li et al, 2009) or α-synuclein oligomers (Danzer et al, 2007) induces neuronal death by activating Ca 2+ dependent signaling pathways and metabolic derangements (Arundine and Tymianski, 2003), most likely by increasing mitochondrial Ca 2+ levels and the release of proapoptotic factors (Orrenius et al, 2003;Beech, 2005 In physiological conditions, activation of G-coupled receptors at the plasma membrane induces the release of Ca 2+ from the ER, which in turn stimuli the influx of extracellular Ca 2+ through a diversity of plasma membrane channels.…”