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Images in Neurology |

The “OK” Sign An Unusual Angiographic Appearance of Basilar Artery Fenestration

Shyam Prabhakaran, MD, MS; Demetrius K. Lopes, MD
Arch Neurol. 2008;65(6):836. doi:10.1001/archneur.65.6.836.
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A 22-year-old woman with a history of headaches underwent brain imaging to exclude structural causes of headache. After magnetic resonance angiography suggested a basilar artery aneurysm, she was referred to our institution for further diagnostic workup. A conventional angiogram was performed and showed a possible aneurysm of the midbasilar segment (Figure A, arrow). Three-dimensional reconstructed images, however, demonstrated that this abnormality was clearly a fenestrated basilar artery without aneurysm. The image simulated an “ok” hand sign (Figure B, arrow) and no further intervention was taken.

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A, Anteroposterior view of a right vertebral artery injection showing small evagination of the midbasilar artery (arrow); B, Three-dimensional reconstruction of conventional angiography reveals clear basilar artery fenestration resembling the “ok” hand sign (arrow).

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