RT Journal Article
SR Electronic
T1 PROBABLE BILATERAL POSTERIOR CEREBRAL ARTERY DISSECTION
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP e4
OP e4
DO 10.1136/jnnp-2014-309236.213
VO 85
IS 10
A1 Lam, Deborah
A1 Siripurapu, Rekha
A1 H, Stockley
A1 Punter, Martin
YR 2014
UL http://jnnp.bmj.com/content/85/10/e4.128.abstract
AB Isolated dissection of the posterior cerebral artery (PCA) is rare. A 68 year old male golf enthusiast developed moderately severe occipital headaches followed two weeks later by transient right sided weakness and speech disturbance. Six weeks later he developed difficulty reading and was found to have left upper quadrantanopia. Blood inflammatory and immunological markers were all normal as was CSF analysis. Initial CT brain showed a small, established left occipital lobe infarct. MR brain showed new right occipital, right thalamic and small left hippocampal infarcts. Transthoracic echocardiogram and arrhythmia recording identified no embolic source. CT and catheter angiography showed occlusion of the right PCA and stenosis of the left PCA. Other intracranial and extracranial vessels were normal. Conventional stroke secondary prevention strategies and steroid therapy was initiated due to initial concern of vasculitis. Follow up MR angiography showed no change in vessel status but interval right PCA infarct. We present the clinical features of this highly unusual case and discuss the radiological findings. In the absence of another identified cause and given the proximity to tentorium, we presume the cause is bilateral PCA dissection.