1. www.afrad.org Case presentation
Posterior inferior cerebellar artery (PICA)
Territory acute ischemic infarct
Hidayatullah Hamidi, Radiology department, FMIC
01/03/2016

2. Demographics and clinical problem
56 years old female presented with vertigo, nausea, vomiting and headache for last 3 days.

3. TECHNIQUE
Brain MRI before and after IV administration of gadolinium.

4. T2WI

5. T2 FlAIR

6. DWI

7. ADC

8. Sagittal MO

9. FINDINGS:
Abnormal T2WI and FLAIR hyper intense and T1WI hypointenses focal areas involving left PICA territory (postero inferior aspect of left cerrebelar hemisphere, left inferior cerebellar vermis and left side of medulla oblongata)
Diffusion restriction: Increased signal in DWI and drop of signal in ADC map
No post contrast enhancement

10. TOF MRA

12. Vertebral a.

15. Time of flight MRA
Non visualization of left vertebral artery, left anterior spinal artery and left PICA representing complete obstruction/thrombosis.

16. CONCLUSION:
Non visualization of left vertebral artery, left anterior spinal artery and left PICA representing complete thrombosis resulting in acute ischemic infarction at the left PICA territory

17. Discussion

18. PICA occlusion May cause infarction of Posterior inferior cerebellum
Inferior cerebellar vermis
Lateral medulla

19. Epidemiology
Typically considered the most common territory involved in cerebellar infarction

20. Clinical presentation
Most common: Vertigo, nausea and truncal ataxia.
Signs of a lateral medullary syndrome (Wallenberg syndrome) may coexist in ~30%.
WS: Acute ischemic infarct due to occlusion of vessels supplying lateral medulla oblongata (intracranial portion of  vertebral a. followed by PICA)
Characterized by: vertigo, falling towards side of lesion, diplopia…

21. PICA territory Inferior occipital surface of cerebellum.

22. PICA territory

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