Sumo-Associated Traumatic Vertebral Artery Dissection Precipitating Subarachnoid Hemorrhage in Association with Bifid Origins of the Posterior Inferior Cerebellar Artery.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 101528275 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-8769 (Electronic) Linking ISSN: 18788750 NLM ISO Abbreviation: World Neurosurg Subsets: MEDLINE
    • Publication Information:
      Original Publication: New York : Elsevier
    • Subject Terms:
      Intracranial Aneurysm/*surgery ; Subarachnoid Hemorrhage/*surgery ; Vertebral Artery/*surgery ; Vertebral Artery Dissection/*surgery; Adolescent ; Aneurysm, Ruptured/complications ; Aneurysm, Ruptured/diagnosis ; Aneurysm, Ruptured/surgery ; Angiography, Digital Subtraction/methods ; Cerebellum/blood supply ; Humans ; Intracranial Aneurysm/complications ; Intracranial Aneurysm/diagnosis ; Male ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/diagnosis ; Vertebral Artery/physiopathology ; Vertebral Artery Dissection/complications ; Vertebral Artery Dissection/diagnosis
    • Abstract:
      Background: Traumatic vertebral artery dissection (tVAD) is frequently accompanied by cerebellar infarction, but subarachnoid hemorrhage (SAH) is rare.
      Case Description: We report a unique case of tVAD precipitating SAH, from which the patient fully recovered, most likely because of the protective effects of an anomalously duplicated posterior inferior cerebellar artery (PICA) origin. A 17-year-old Sumo wrestler experienced a brief loss of consciousness after an attack by an opponent to his neck. Head computed tomography imaging demonstrated diffuse posterior fossa SAH; cerebral angiography demonstrated left vertebral artery (VA) occlusion, which was thought to be most likely attributable to tVAD. Angiography revealed distal PICA reconstitution, supplied by collateral arterial flow from the meningeal branch of the proximal ipsilateral VA. An external ventricular drain was placed acutely for treatment of SAH-induced hydrocephalus; however, the patient had an otherwise uneventful course, and remained without clinical evidence of ischemic infarct. A repeat imaging confirming a probable duplicated PICA origin from the VA, distal to the tVAD-associated thrombosis.
      Conclusions: Of particular interest, the patient's abnormal anatomy may have been a mixed blessing, with a more fragile bifid PICA potentially underlying the unexpected development of SAH, whereas the sister branch simultaneously spared him a potentially catastrophic infarction via arterial collateralization.
      (Copyright © 2019 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Arterial dissection; Collateral artery; Posterior inferior cerebellar artery; Traumatic subarachnoid hemorrhage; Vertebral artery
    • Publication Date:
      Date Created: 20191015 Date Completed: 20200305 Latest Revision: 20200305
    • Publication Date:
      20221213
    • Accession Number:
      10.1016/j.wneu.2019.09.164
    • Accession Number:
      31610246