![]() ![]() ![]() To our knowledge, this is the first case report of a patient with unruptured PICA aneurysm presenting with lateral medullary syndrome. There have been limited studies on unruptured intracranial aneurysm causing ischemic stroke. His 3-month follow-up in our clinic showed only minimal deficits.Ĭerebral angiogram showing successful coiling of the PICA aneurysm. A cerebral angiogram confirmed a small, unruptured, and nonthrombosed right PICA aneurysm (4 × 3.5 mm), which was later treated with coiling (Fig. A transthoracic echo was unremarkable for any acute findings. An MR angiogram of the head and neck indicated a right small PICA aneurysm (Fig. Brain MRI revealed a restricted diffusion on the right lateral medulla consistent with an acute lateral medullary infarction. The patient did not receive intravenous thrombolysis secondary to his elevated INR. His physical examination was significant for right horizontal gaze nystagmus, right facial sensory deficits along with facial weakness, decreased palate elevation on the right, right tongue deviation, right-sided limb ataxia, and decreased sensation on the left side of the body. Initial laboratory studies indicated a therapeutic INR of 2.6 otherwise his medical history was unremarkable. He complied with his medications and his home medication regimen included warfarin, atenolol, and atorvastatin. His past medical history was significant for hypertension and aortic dissection (status post mechanical aortic valve on Coumadin with therapeutic INR). Case PresentationĪ 59-year-old Caucasian man presented to the emergency department with chief complaints of acute right facial numbness and weakness, vertigo, blurred vision, and nausea. Here we describe a patient who presented with lateral medullary acute infarction associated with a small and unruptured PICA aneurysm. Although giant thrombosed aneurysms can cause cerebral ischemia, it is a very rare manifestation of small (<10 mm) intracranial aneurysms. The most common complication of intracranial aneurysms is rupture causing subarachnoid hemorrhage. Posterior inferior cerebellar artery (PICA) aneurysms are a rare form of intracranial aneurysms (5.6–6.6%).
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