Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Cho, In-Yang (Department of Neurosurgery, College of Medicine, Ewha Womans University) ;
  • Hwang, Sung-Kyun (Department of Neurosurgery, College of Medicine, Ewha Womans University)
  • Received : 2011.05.09
  • Accepted : 2012.03.19
  • Published : 2012.03.28
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Ali MJ, Bendok BR, Tawk RG, Getch CC, Batjer HH : Trapping and revascularization for a dissecting aneurysm of the proximal posteroinferior cerebellar artery : technical case report and review of the literature. Neurosurgery 51 : 258-262; discussion 262-263, 2002 https://doi.org/10.1097/00006123-200207000-00043
  2. Dinichert A, Rüfenacht DA, Tribolet N : Dissecting aneurysms of the posterior inferior cerebellar artery : report of four cases and review of the literature. J Clin Neurosci 7 : 515-520, 2000 https://doi.org/10.1054/jocn.2000.0757
  3. Fischer CM, Karnes WE, Kubik CS : Lateral medullary infarction-the pattern of vascular occlusion. J Neuropathol Exp Neurol 20 : 323-379, 1961 https://doi.org/10.1097/00005072-196107000-00001
  4. Garcia-Garcia J, Ayo-Martin O, Segura T : Lateral medullary syndrome and ipsilateral hemiplegia (Opalski syndrome) due to left vertebral artery dissection. Arch Neurol 66 : 1574-1575, 2009 https://doi.org/10.1001/archneurol.2009.268
  5. Giannopoulos S, Markoula S, Kosmidou M, Pelidou SH, Kyritsis AP : Lateral medullary ischaemic events in young adults with hypoplastic vertebral artery. J Neurol Neurosurg Psychiatry 78 : 987-989, 2007 https://doi.org/10.1136/jnnp.2006.106419
  6. Hamada J, Kai Y, Morioka M, Yano S, Todaka T, Ushio Y : Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage. J Neurosurg 99 : 960-966, 2003 https://doi.org/10.3171/jns.2003.99.6.0960
  7. Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, et al. : Dissecting aneurysms of the vertebral artery : a management strategy. J Neurosurg 97 : 259-267, 2002 https://doi.org/10.3171/jns.2002.97.2.0259
  8. Iwabuchi S, Yokouchi T, Kimura H, Ueda M, Samejima H : Rupture of a large vertebral artery aneurysm following proximal occlusion. Interv Neuroradiol 11 : 51-58, 2005
  9. Jao T, Liu HM, Tang SC, Jeng JS : Dissection of the posterior inferior cerebellar artery in a young adult with cerebellar infarct. Acta Neurol Taiwan 17 : 243-247, 2008
  10. Jeon SG, Kwon do H, Ahn JS, Kwun BD, Choi CG, Jin SC : Detachable coil embolization for saccular posterior inferior cerebellar artery aneurysms. J Korean Neurosurg Soc 46 : 221-225, 2009 https://doi.org/10.3340/jkns.2009.46.3.221
  11. Kakino S, Ogasawara K, Kubo Y, Otawara Y, Tomizuka N, Suzuki M, et al. : Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion. Surg Neurol 61 : 185-189; discussion 189, 2004 https://doi.org/10.1016/j.surneu.2003.06.001
  12. Kwon M, Lee JH, Kim JS : Dysphagia in unilateral medullary infarction : lateral vs medial lesions. Neurology 65 : 714-718, 2005 https://doi.org/10.1212/01.wnl.0000174441.39903.d8
  13. Lee JM, Kim TS, Joo SP, Yoon W, Choi HY : Endovascular treatment of ruptured dissecting vertebral artery aneurysms--long-term follow-up results, benefits of early embolization, and predictors of outcome. Acta Neurochir (Wien) 152 : 1455-1465, 2010 https://doi.org/10.1007/s00701-010-0683-9
  14. Lewis SB, Chang DJ, Peace DA, Lafrentz PJ, Day AL : Distal posterior inferior cerebellar artery aneurysms : clinical features and management. J Neurosurg 97 : 756-766, 2002 https://doi.org/10.3171/jns.2002.97.4.0756
  15. Mahmood A, Dujovny M, Torche M, Dragovic L, Ausman JI : Microvascular anatomy of foramen caecum medullae oblongatae. J Neurosurg 75 : 299-304, 1991 https://doi.org/10.3171/jns.1991.75.2.0299
  16. Mizushima H, Sasaki K, Kunii N, Nishino T, Jinbo H, Abe T, et al. : Dissecting aneurysm in the proximal region of the posterior inferior cerebellar artery presenting as Wallenberg's syndrome--case report. Neurol Med Chir (Tokyo) 34 : 307-310, 1994 https://doi.org/10.2176/nmc.34.307
  17. Nguyen TN, Roy D, Guilbert F, Raymond J, Weill A : Endovascular trapping of a vertebral artery segment to control PICA origin tearing. J Neuroimaging 18 : 418-421, 2008 https://doi.org/10.1111/j.1552-6569.2007.00195.x
  18. Ogasawara K, Kubo Y, Tomitsuka N, Sasoh M, Otawara Y, Arai H, et al. : Treatment of vertebral artery aneurysms with transposition of the posterior inferior cerebellar artery to the vertebral artery combined with parent artery occlusion. Technical note. J Neurosurg 105 : 781-784, 2006 https://doi.org/10.3171/jns.2006.105.5.781
  19. Okuchi K, Watabe Y, Hiramatsu K, Tada T, Sakaki T, Kyoi K, et al. : [Dissecting aneurysm of the vertebral artery as a cause of Wallenberg's syndrome]. No Shinkei Geka 18 : 721-727, 1990
  20. Paliwal VK, Kalita J, Misra UK : Dysphagia in a patient with bilateral medial medullary infarcts. Dysphagia 24 : 349-353, 2009 https://doi.org/10.1007/s00455-008-9194-8
  21. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB : Posterior inferior cerebellar artery aneurysms : incidence, clinical presentation, and outcome of endovascular treatment. AJNR Am J Neuroradiol 29 : 86-90, 2008 https://doi.org/10.3174/ajnr.A0758
  22. Porto FH, da Silva SP, Orsini M, de Freitas MR, de Freitas GR : Hemimedullary infarct with ipsilateral hemiplegia : a vertebral artery dissection syndrome? J Neurol Sci 278 : 135-137, 2009 https://doi.org/10.1016/j.jns.2008.11.025
  23. Redekop G, TerBrugge K, Willinsky R : Subarachnoid hemorrhage from vertebrobasilar dissecting aneurysm treated with staged bilateral vertebral artery occlusion : the importance of early follow-up angiography : technical case report. Neurosurgery 45 : 1258-1262; discussion 1262-1263, 1999 https://doi.org/10.1097/00006123-199911000-00056
  24. Shioya H, Kikuchi K, Suda Y, Shindo K : [Atypical Wallenberg's syndrome due to spontaneous vertebral arterial dissection : case report]. No To Shinkei 56 : 519-524, 2004
  25. Yamaura A, Watanabe Y, Saeki N : Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72 : 183-188, 1990 https://doi.org/10.3171/jns.1990.72.2.0183
  26. Yamaura I, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, et al. : Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90 : 853-856, 1999 https://doi.org/10.3171/jns.1999.90.5.0853
  27. Yasui T, Komiyama M, Nishikawa M, Nakajima H : Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery : report of two cases and review of the literature. Neurosurgery 46 : 196-200; discussion 200-201, 2000 https://doi.org/10.1093/neurosurgery/46.1.196
  28. Yeh HF, Seak CJ, Chiu TF, Chang YC : Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision. Am J Emerg Med 27 : 131, e1-e3, 2009

Cited by

  1. A Case of Lateral Medullary Artery Arisen from the Posterior Meningeal Artery vol.11, pp.12, 2012, https://doi.org/10.5797/jnet.cr.2017-0038
  2. 척추기저동맥박리에 의한 소뇌경색 환자 한방치험 1례 vol.38, pp.5, 2012, https://doi.org/10.22246/jikm.2017.38.5.709
  3. A Case of Posterior Inferior Cerebellar Artery Infarction after Cervical Chiropractic Manipulation vol.14, pp.2, 2012, https://doi.org/10.13004/kjnt.2018.14.2.159
  4. Incidence and Risk Factors for Dysphagia Following Non-traumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study vol.34, pp.2, 2012, https://doi.org/10.1007/s00455-018-9934-3
  5. The Silk Vista Baby: Initial experience and report of two cases vol.25, pp.5, 2012, https://doi.org/10.1177/1591019919839196
  6. Occipital artery to p3 segment of posterior inferior cerebellar artery bypass in treating a complex fusiform aneurysm vol.13, pp.6, 2012, https://doi.org/10.1136/bcr-2020-235023
  7. Dysphagia in non-traumatic subarachnoid haemorrhage: a scoping review vol.43, pp.4, 2012, https://doi.org/10.1007/s10143-019-01155-8