Small Pontine Infarction Secondary to Posterior Inferior Cerebellar Artery (PICA) Atherosclerosis: The Diagnostic Value of 3 Tesla MRI

Posterior circulation strokes, particularly those involving the posterior inferior cerebellar artery (PICA), often present with nonspecific symptoms, such as vertigo, frequently leading to misdiagnosis as peripheral vestibular disorders. Identifying small lacunar infarcts in these regions requires high-resolution neuroimaging. A 65-year-old female with a history of hypertension and dyslipidemia presented with sudden-onset rotatory vertigo, headache, and right-sided paresthesia (National Institutes of Health Stroke Scale {NIHSS}=2). The 3 Tesla MRI revealed a 5-mm acute ischemic focus in the left pons on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) sequences. Three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) demonstrated multifocal atherosclerotic stenosis along the left PICA. The patient was managed with dual antiplatelet therapy (DAPT) (clopidogrel 75 mg and aspirin 100 mg), high-intensity statin (rosuvastatin 20 mg), and stringent blood pressure control. Following seven days of treatment, clinical symptoms improved significantly, and the patient was discharged in stable condition. The 3 Tesla MRI is a pivotal tool for detecting small-core infarcts and evaluating detailed atherosclerotic changes in the posterior circulation. Integrating clinical vigilance with advanced imaging facilitates accurate diagnosis and optimizes medical management to prevent recurrent stroke.