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Images in Neurology |

Basiparallel Anatomic Scanning–Magnetic Resonance Imaging in Vertebral Artery Dissection

Tsuyoshi Hamaguchi, MD, PhD; Masahito Yamada, MD, PhD
Arch Neurol. 2009;66(2):276-277. doi:10.1001/archneurol.2008.528.
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A 48-year-old woman without serious past illness experienced sudden severe pain in the right occipital region (day 1). Physical examination at an outpatient clinic on day 2 did not disclose any abnormality. Severe headache persisted, and the patient reported dysphagia and gait instability on day 6. Further, hypoesthesia on the left side of the body developed on day 8. She came to our hospital on day 14. Physical examination demonstrated mild hypertension (blood pressure 146/96 mm Hg), direction nystagmus to the right, weakness of the right pharyngeal muscle, and hypoesthesia on the left side of the body. Cerebral infarction was detected on the right lateral side of the lower medulla oblongata on magnetic resonance imaging (MRI) (Figure 1). At basiparallel anatomic scanning (BPAS)–MRI,1 the outer diameter of the right vertebral artery (VA) was dilated (Figure 2A), the true lumen had narrowed on 3-dimension (3-D) time-of-flight magnetic resonance angiography (MRA) (Figure 2C), and the pseudolumen was full of thrombus on T1-weighted MRI (Figure 2E). A diagnosis of right-sided Wallenberg syndrome with right vertebral artery dissection was made. Blood pressure was moderately controlled (110/75 mm Hg) with medication.

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Figure 1.

T2-weighted magnetic resonance image of the brain on day 14. High intensity is seen on the right lateral side of the lower medulla oblongata (arrow). A indicates anterior; L, left side.

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Figure 2.

At basiparallel anatomic scanning–magnetic resonance imaging, the right vertebral artery was demonstrated as a fusiform dilatation on day 14 (A; arrows) but had narrowed by day 109 (B; arrows). At 3-dimension time-of-flight magnetic resonance angiography, the right vertebral artery was not visualized clearly on day 14 (C; arrow) but was clearly seen on day 109 (D; arrow). High intensity was detected in the right vertebral artery on T1-weighted images on day 14 (E; arrow) but was not noted on day 109 (F; arrow). A indicates anterior; H, head; and L, left side.

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