Progressive Bilateral Vertebral Artery Dissection in a Case of Osteogenesis Imperfecta Yuji Kato, MD, PhD, Harumitsu Nagoya, MD, PhD, Tetsuya Abe, MD,

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Progressive Bilateral Vertebral Artery Dissection in a Case of Osteogenesis Imperfecta Yuji Kato, MD, PhD, Harumitsu Nagoya, MD, PhD, Tetsuya Abe, MD, Takeshi Hayashi, MD, PhD, Masanori Yasuda, MD, PhD, Akira Uchino, MD, PhD, Norio Tanahashi, MD, PhD, Masaki Takao, MD, PhD Journal of Stroke and Cerebrovascular Diseases Volume 26, Issue 3, Pages e43-e46 (March 2017) DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.012 Copyright © 2017 National Stroke Association Terms and Conditions

Figure 1 Abbreviated family pedigree. The square indicates a man and the circle indicates a woman. Dark squares and circles indicate a history of multiple fractures. An asterisk indicates the present case. Journal of Stroke and Cerebrovascular Diseases 2017 26, e43-e46DOI: (10.1016/j.jstrokecerebrovasdis.2016.12.012) Copyright © 2017 National Stroke Association Terms and Conditions

Figure 2 Diffusion-weighted MR imaging (A) performed on admission shows hyperintensity in the right posterolateral medulla (arrow). T1-weighted MR imaging (B), MR angiography (C), and a partial maximum intensity projection image of the vertebrobasilar system (D) show occlusion of the right VA with thrombus in the pseudolumen (arrowheads) and dilation of the proximal basilar artery (BA) (arrow). MR angiographic source image (E) shows a double lumen in the right occluded VA (arrow). Basi-parallel anatomical scanning-MR imaging (F) shows dilatation of the outer contour at the right VA (arrowheads) and the proximal BA (arrow). Abbreviations: MR, magnetic resonance; VA, vertebral artery. Journal of Stroke and Cerebrovascular Diseases 2017 26, e43-e46DOI: (10.1016/j.jstrokecerebrovasdis.2016.12.012) Copyright © 2017 National Stroke Association Terms and Conditions

Figure 3 Three-dimensional computed tomography angiography on admission shows occlusion in the right vertebral artery (A, arrow) and dilation of the proximal basilar artery (A, B, arrowhead), although there appears to be retrograde residual flow (B, arrow). Journal of Stroke and Cerebrovascular Diseases 2017 26, e43-e46DOI: (10.1016/j.jstrokecerebrovasdis.2016.12.012) Copyright © 2017 National Stroke Association Terms and Conditions

Figure 4 MR angiography (A) and a partial maximum intensity projection (MIP) image of the vertebrobasilar system (B) on day 11 showing left VA dissection with severe stenosis (string sign, arrows). MR angiography (C, arrowheads) and an MIP image of the vertebrobasilar system (D, arrowheads) on day 18 show enlargement of the pseudolumen in the left dissecting VA. Abbreviations: MR, magnetic resonance; VA, vertebral artery. Journal of Stroke and Cerebrovascular Diseases 2017 26, e43-e46DOI: (10.1016/j.jstrokecerebrovasdis.2016.12.012) Copyright © 2017 National Stroke Association Terms and Conditions

Figure 5 Brain computed tomography on day 20 shows diffuse subarachnoid hemorrhage. Journal of Stroke and Cerebrovascular Diseases 2017 26, e43-e46DOI: (10.1016/j.jstrokecerebrovasdis.2016.12.012) Copyright © 2017 National Stroke Association Terms and Conditions