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Neuroradiology Case of the Day

¹ Department of Radiology, University of South Alabama Medical Center, 2451 Fillingim St, Mastin Bldg 301, Mobile, AL 36617.

View larger version (136K): [in a new window]   Figure 1a.  (a) Axial intermediate weighted MR image of the cerebellum reveals an area of increased signal intensity in the left cortical gray matter (arrow). Both vertebral arteries are visualized (the right larger than the left) with apparent flow voids (arrowheads). (b) T2-weighted MR image obtained at the same level as a again shows high signal intensity in the gray matter of the left cerebellum (arrow). Vessel flow on the left side is not as well visualized due to cerebrospinal fluid signal.

View larger version (132K): [in a new window]   Figure 1b.  (a) Axial intermediate weighted MR image of the cerebellum reveals an area of increased signal intensity in the left cortical gray matter (arrow). Both vertebral arteries are visualized (the right larger than the left) with apparent flow voids (arrowheads). (b) T2-weighted MR image obtained at the same level as a again shows high signal intensity in the gray matter of the left cerebellum (arrow). Vessel flow on the left side is not as well visualized due to cerebrospinal fluid signal.

View larger version (152K): [in a new window]   Figure 2.  Axial T2-weighted MR image through the brain stem reveals additional areas of infarct in the brain stem and cerebellum (arrow). The hypoglossal nucleus is involved.

View larger version (81K): [in a new window]   Figure 3a.  (a) Axial three-dimensional time-of-flight MR angiogram shows a normal basilar artery (arrowhead), carotid artery, and right vertebral artery (curved arrow) intracranially. The left vertebral artery has reduced flow (straight arrow). (b) Coronal three-dimensional time-of-flight MR angiogram reveals irregular contour and reduced flow in the left vertebral artery between the transverse foramen of C2 and C1 (curved arrows). The large vessels lateral to the vertebral artery (straight arrow) are jugular veins that could not be totally suppressed on the image due to the angle of acquisition.

View larger version (149K): [in a new window]   Figure 3b.  (a) Axial three-dimensional time-of-flight MR angiogram shows a normal basilar artery (arrowhead), carotid artery, and right vertebral artery (curved arrow) intracranially. The left vertebral artery has reduced flow (straight arrow). (b) Coronal three-dimensional time-of-flight MR angiogram reveals irregular contour and reduced flow in the left vertebral artery between the transverse foramen of C2 and C1 (curved arrows). The large vessels lateral to the vertebral artery (straight arrow) are jugular veins that could not be totally suppressed on the image due to the angle of acquisition.

View larger version (106K): [in a new window]   Figure 4a.  (a) Lateral digital subtraction angiogram of the left vertebral artery reveals a reduction in the diameter of the artery extracranially (arrow). The intracranial vertebral and basilar arteries and the anterior inferior cerebellar artery appear normal (arrowheads). (b) Left anterior oblique digital subtraction angiogram shows an irregular narrowing of the vertebral artery between C2 and C1 (straight arrow). Curved arrow indicates a branch vessel feeding the anterior spinal artery. (c) Right anterior oblique digital subtraction angiogram again shows irregular narrowing of the dissected lumen (arrow) with a return to normal morphology intracranially.

View larger version (120K): [in a new window]   Figure 4b.  (a) Lateral digital subtraction angiogram of the left vertebral artery reveals a reduction in the diameter of the artery extracranially (arrow). The intracranial vertebral and basilar arteries and the anterior inferior cerebellar artery appear normal (arrowheads). (b) Left anterior oblique digital subtraction angiogram shows an irregular narrowing of the vertebral artery between C2 and C1 (straight arrow). Curved arrow indicates a branch vessel feeding the anterior spinal artery. (c) Right anterior oblique digital subtraction angiogram again shows irregular narrowing of the dissected lumen (arrow) with a return to normal morphology intracranially.

View larger version (156K): [in a new window]   Figure 4c.  (a) Lateral digital subtraction angiogram of the left vertebral artery reveals a reduction in the diameter of the artery extracranially (arrow). The intracranial vertebral and basilar arteries and the anterior inferior cerebellar artery appear normal (arrowheads). (b) Left anterior oblique digital subtraction angiogram shows an irregular narrowing of the vertebral artery between C2 and C1 (straight arrow). Curved arrow indicates a branch vessel feeding the anterior spinal artery. (c) Right anterior oblique digital subtraction angiogram again shows irregular narrowing of the dissected lumen (arrow) with a return to normal morphology intracranially.