A 46-year-old man with right-sided posterior neck pain, dizziness, and vomiting was admitted to our hospital. Initial magnetic resonance imaging (MRI) revealed a right cerebellar infarction; however, it was inconclusive for the diagnosis of dissection. Computed tomography angiography (CTA) and curved planar reconstruction (CPR) images revealed wall deformity and beaded stenosis in the lateral medullary segment of the posterior inferior cerebellar artery (PICA), leading to a diagnosis of isolated PICA dissection. CTA findings preceded the appearance of an intramural hematoma on MRI. CTA may offer a better morphological evaluation than MRI, especially for small vessels in the early phase.
Eto et al. (2025) studied this question.