Abstract
We present a case of distal posterior inferior cerebellar artery (PICA) dissection with subarachnoid hemorrhage that was difficult to diagnose. A 72-year-old woman with a 2-year history of saccular cerebral aneurysm clipping presented with recurrent subarachnoid hemorrhage. Angiograms after the first and second subarachnoid hemorrhage showed irregular stenosis of the distal PICA that was thought to be arteriosclerotic change because of the same finding on previous angiograms. After the third subarachnoid hemorrhage, angiogram revealed aneurysmal dilatation from the irregular stenosis of the distal PICA. Based on the clinical course and interval change in angiographic findings after each episode, this patient was diagnosed with a distal PICA dissecting aneurysm with a hemorrhagic onset and was successfully treated with endovascular surgery. We present this case with a review of the literature.
