Posterior Cerebral Artery Infarction from Vertebral Artery Dissection

Right posterior cerebral artery ischemic infarction due to post traumatic (martial arts) left vertebral artery dissection with resulting right PCA occlusion. Left homonymous hemianopia due to right occipital lobe infarction and left hemisensory loss due to right thalamic infarction. Imaging of the acute infarct on MRI and of the old infarct on CT; vascular imaging on MRA. Figure 1 : Complete Left Homonymous Hemianopia on Humphrey visual fields (a: left eye; b: right eye) Figures 2 to 5:Brain MRI (performed 8 hours after symptom onset). a : Diffusion Weighted Images (DWI) and b : Apparent Diffusion Coefficient (ADC). Note the hyperintense (bright) areas on DWI (red arrows) with corresponding dark on ADC (green arrows) indicating acute infarction in right PCA territory (occipital and inferior temporal lobes) Figure 6 : MRA of the head with contrast (Source Images). Note the lack of flow-related signal in left VA (green circle), with minimal signal visualized in only most proximal VA (green arrows) near vertebrobasilar junction. Normal flow-related signal in bilateral ICAs and right VA (red arrows). Figure 7 : MRA of the head with contrast (Source Images). The right PCA (red arrows) is visualized at its takeoff from basilar artery (yellow arrow) with initial flow-related signal, followed by loss of signal (red circle). Left PCA visualized on all slices for comparison (blue arrows). Figure 8 : MRA Head with contrast (3D reconstructions). Note lack of visualization of the left VA (green arrows) and right PCA (red arrow) compared to normal (dominant) right VA and left PCA (blue arrow). Figure 9 : Head CT without contrast (2.5 weeks later). Hypodensity (red arrows) in right occipital and inferior temporal lobes corresponding to old infarction (2.5 weeks)