Extracranially located PICA aneurysm presenting with supratentorial IVH: A rare event with diagnostic pitfalls

Amey Savardekar; Manoj Kumar Tewari; Rajeev Garg; Vivek Gupta; Chirag Ahuja

doi:10.4103/0976-3147.116430

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Case Report

4 (

Supp 1

); S99-S101

doi:

10.4103/0976-3147.116430

Extracranially located PICA aneurysm presenting with supratentorial IVH: A rare event with diagnostic pitfalls

Amey Savardekar^,, Manoj Kumar Tewari, Rajeev Garg, Vivek Gupta, Chirag Ahuja

Department of Neurosurgery, Chandigarh, India

1 1Department of Radiology, PGIMER, Chandigarh, India

Prof. Manoj Kumar Tewari Department of Neurosurgery, PGIMER Chandigarh India manojktewari@gmail.com

Journal of Neurosciences in Rural Practice

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This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

ABSTRACT

Extracranially located posterior inferior cerebellar artery (PICA) aneurysms are rare with only 21 cases reported till date. They may arise either from the proximal segment of an extracranially originating PICA or from the tip of its caudal loop when it dips below the foramen magnum. A 16-year-old female presenting with sudden onset severe headache and intraventricular hemorrhage (IVH) in the occipital horns of the lateral ventricle and the fourth ventricles, was diagnosed to have an extracranial proximal segment PICA aneurysm on a four vessel digital subtraction angiography (DSA), after initially missing it on the brain magnetic resonance imaging (MRI) with angiogram (MRA) because of its extracranial location. During surgery, the aneurysm was clipped following a far lateral suboccipital craniectomy with C1‑C2 hemilaminectomy. The patient showed good recovery. Thus, we emphasize the need for a dedicated four vessel angiography to diagnose such lesions.

Keywords

Extracranial aneurysm

intraventricular hemorrhage

PICA aneurysm

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Conflict of Interest

None declared

References

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[1] Dammers R, Krisht A. F., Partington S, . Diagnosis and surgical management of extracranial PICA aneurysms presenting through subarachnoid haemorrhage: Case report and review of the literature. Clin Neurol Neurosurg. 2009;111:758-61.
[Google Scholar]

[2] Tanaka A, Kimura M, Yoshinaga S, Tomonaga M, . Extracranial aneurysm of the posterior inferior cerebellar artery: Case report. Neurosurgery. 1993;33:742-4.
[Google Scholar]

[3] Bhat D. I., Somanna S, Kovoor J, Chandramouli B. A., . Aneurysms from extracranial, extradurally originating posterior inferior cerebellar arteries: Arare case report. Surg Neurol. 2009;72:406-8.
[Google Scholar]

[4] Lister J. R., Rhoton A. L. Jr, Matsushima T, Peace D. A., . Microsurgical anatomy of the posterior inferior cerebellar artery. Neurosurgery. 1982;10:170-99.
[Google Scholar]

[5] Nakamura H, Tanaka T, Hiyama T, Okubo S, Kudo T, Kobayashi H, et al . Subarachnoid hemorrhage caused by ruptured dissecting aneurysm arising from the extracranial distal posterior inferior cerebellar artery: Case report. Neurol Med Chir (Tokyo). 2010;50:41-4.
[Google Scholar]

[6] Ruelle A, Cavazzani P, Andrioli G, . Extracranial posterior inferior cerebellar artery aneurysm causing isolated intraventricular hemorrhage: A case report. Neurosurgery. 1988;23:774-7.
[Google Scholar]

[7] Abe T, Kojima K, Singer R. J., Marks M. P., Watanabe M, Ohtsuru K, et al . Endovascular management of an aneurysm arising from posterior inferior cerebellar artery originated at the level of C2. Radiat Med. 1998;16:141-3.
[Google Scholar]

[8] Chen C. J., Chen S. T., . Extracranial distal aneurysm of posterior inferior cerebellar artery. Neuroradiology. 1997;39:344-7.
[Google Scholar]

[9] Krayenbuhl N, Guerrero C, Krisht A. F., . Technical strategies to approach aneurysms of the vertebral and posterior inferior cerebellar arteries. Neurosurg Focus.. 2005;19:E4.
[Google Scholar]

Extracranially located PICA aneurysm presenting with supratentorial IVH: A rare event with diagnostic pitfalls

Abstract

ABSTRACT

Keywords

Extracranial aneurysm

intraventricular hemorrhage

PICA aneurysm

Conflict of Interest

References

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