![]() ĭzierzanowski J, Szarmach A, Bascik B, Czapiewski P, Muc A, Piskunowicz M. Magklara EP, Pantelia ET, Solia E, Panagouli E, Piagkou M, Mazarakis A, Vertebral artery variations revised: origin, course, branches and embryonic development. Morphometric study for the intracranial portion of the vertebral artery in human cadavers. Microsurgical anatomy of the intracranial part of the vertebral artery. Microsurgical Anatomy of the Posterior Inferior Cerebellar Artery. In conclusion, PICA is very important in clinical practice.Īnatomy aneurysms clinical importance posterior inferior cerebellar artery. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. ![]() The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). PICA injured by head trauma can cause fatal SAH. Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA has tortuous and variable course and territory, divided into 5 segments. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. However, a comprehensive systematic review of the importance of the PICA is currently lacking. Pure gain-based vHIT analysis seems limited and needs to be incorporated with saccade analysis.Īcute vestibular syndrome head impulse test posterior circulation stroke vestibular neuritis video-oculography based head impulse test.The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. These findings indicate the strength of clinical HIT. vHIT does not appear to yield additional diagnostic information. Subgroup analyses according to presence of brainstem involvement revealed bilateral low gain (p < 0.05) in patients with brainstem infarction (anterior inferior cerebellar artery-posterior inferior cerebellar artery stroke, AICA-PICA stroke) whereas patients with pure cerebellar infarction (posterior inferior cerebellar artery-superior cerebellar artery stroke, PICA-SCA stroke) had gain values similar to healthy controls.With a gain cut-off ≤0.75 and gain asymmetry cut-off ≥17%, as determined by ROC analysis, 100% of PCS patients and 80% of VN patients were correctly diagnosed.Ĭlinical HIT, either performed by an emergency specialist or neurologist is equivalent to vHIT gain and gain asymmetry analysis as conducted by neuro-otologist in the diagnosis of PCS, albeit mislabeling about 20% of VN patients. However, gain asymmetry was not significant. All patients in this group had normal DWI-MRI.PCS patients had bilaterally low gain (p < 0.05) on vHIT. In all PCS patients, HIT was recorded as normal both by the emergency specialist and the neurologist (100%).On vHIT, patients with VN had significantly low gain values for both the ipsilesional and contralesional sides when compared with the healthy controls, with significantly lower figures for the ipsilesional side (p < 0.001). ![]() Final diagnoses were VN in 24 and PCS in 16 patients.In the VN group, clinical HIT was assessed as abnormal in 19(80%) cases by the emergency specialist and in 20(83%) by the neurologist. vHIT was conducted by an neuro-otology research fellow.įorty patients 26 male, 14 female with a mean age of 49 years were included in the analyses. An emergency specialist and a neurologist performed HIT. Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS).
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