Susceptibility-weighted imaging is a key diagnostic tool for isolated posterior inferior cerebellar arterial dissection: a case report

Abstract Background The diagnosis of isolated posterior inferior cerebellar artery (PICA) dissection poses challenges because of the diminutive caliber and convoluted nature of these vessels. This report aimed to highlight the potential superiority of susceptibility-weighted imaging (SWI) in the early detection of intramural hematoma. Case presentation We encountered a case of transient lateral medullary syndrome by isolated PICA dissection. The diagnosis was based on observation of chronological changes on magnetic resonance angiography and the appearance of subtle signal on T1-sampling perfection with application-optimized contrasts using different flip angle evolutions (T1-SPACE) in the proximal portion of the PICA. Intramural hematoma on SWI appeared earlier and was more conspicuous than signal changes seen on T1-SPACE. Conclusion The standard diagnostic criteria for intracranial artery dissection do not include SWI findings; however, the present findings indicate that SWI may offer superior diagnostic efficacy to T1-SPACE, especially in the early stage and after the onset of isolated PICA dissection with a small amount of intramural hematoma.