Your SlideShare is downloading. ×
Right AICA PICA stroke
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Right AICA PICA stroke

829
views

Published on

Series of cases presented at the weekly neurovascular conference.

Series of cases presented at the weekly neurovascular conference.


0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
829
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Neurovascular ConferenceFarrukh Chaudhry, MD. Neurovascular FellowDaniel Vela-Duarte, MD. PGY-2
  • 2. Patient 2Sudden onset emesis and vertigo
  • 3. History of Present Illness• 74 y/o right handed AA man with: • Sudden onset emesis at 10 am • By 1 am, the emesis started again accompanied by severe vertigo and headache• Taken to an outside ED where he was found to have: • Right hemiparesis • Head CT unremarkable • Transfer to Loyola for further care • 6 hours after the onset of symptoms • No IV thrombolysis at outside institution• Prior history of stroke in early 30s, BPH and HTN• His son died from large stroke in his 30s as well
  • 4. Neurological exam• Corneal anesthesia on the right – Decreased right corneal response• Impaired abduction of the right eye• Mild horizontal/rotary nystagmus on far right lateral gaze• Lower motor neuron facial paresis on the right• Deafness right ear• Right sided hemiataxia• Right sided truncal lateropulsion• Hypalgesia and thermoanesthesia of the right face (onion skin pattern) and left hemibody
  • 5. Localization
  • 6. Diffusion-weighted images.
  • 7. MRA Carotids MRA A1 segment of the R ACA (Congenital hypoplasia) R Vert is dominant L vert originates from aortic arch
  • 8. MRA Vertebrals MRA R Vert is dominant L vert originates from aortic arch
  • 9. Ancillary Data• Echocardiogram: – LV Ejection Fraction: 60 % – Mild LV hypertrophy – Mild LA enlargement• Lipid panel : Chol: 166 | Trigl: 52 | HDL: 47 | LDL: 111• HgbA1c: 5.6• BMP normal | CBC: mild anemia• EKG with NSR• Telemetry monitoring without any events
  • 10. Day # 2. F/ Up CT
  • 11. Cerebellum blood supply.The PICA arises from the vertebral Art. and courses transversely anddownward along the medulla. The common trunk gives rise to themedial branch (medPICA) and the lateral branch (latPICA).
  • 12. Distribution of blood supply.
  • 13. Cerebellar Strokes• PICA 40%• SCA 36%• AICA 12%• Multiple vascular territories 12%
  • 14. Clinical Presentation of PICA infarcts• Structures affected – Inferior surface of cerebellar hemisphere/inferior cerebellar peduncle – Spinothalamic tract – Descending sympathetic pathway – Descending tract of Vth nerve – Vestibular nuclei – Nucleus ambiguous• Clinical presentation• Ipsilateral • Contralateral • Horner’s syndrome • Hemibody hypesthesia & • Facial hypesthesia & thermoanesthesia thermoanesthesia • Vertigo • Hemiataxia • Hoarseness • Palatal asymmetry • Dysphagia
  • 15. Clinical Presentation of AICA infarcts• Structures affected – Brachium pontis – Spinothalamic tract – Descending sympathetic pathway – VII nerve intra-axial fascicular portion – Descending tract of Vth nerve – Vestibular nuclei – Cochlear nucleus• Clinical presentation• Ipsilateral • Contralateral • Horner’s syndrome • Hemibody hypesthesia & • Facial weakness thermoanesthesia • Facial hypesthesia & • Vertigo thermoanesthesia • Nystagmus • Hemiataxia • Deafness
  • 16. Discussion
  • 17. Why presence of Bell’s phenomena and Dysartrhia• Because the medial branch of PICA participates in the blood supply of the medulla in its rostral region• Up to 30% of the PICA distribution infarctions also involve the lateral medulla, resulting in ipsilateral Horner Syndrome / decreased sensation in the ipsilateral trigeminal distribution• Dysarthria: Speech Ataxia