A 50-year-old woman presented with rare multiple
dissecting aneurysms that appeared first in the anterior cerebral artery (ACA) and shortly afterwards in the vertebral artery (VA). She initially suffered sudden motor weakness in the left lower limb due to acute
brain infarction. Angiography revealed diffuse string sign in the right ACA.
Conservative treatment resulted in resolution of the deficits. Follow-up angiography performed 1 year later revealed recovery of the ACA
stenosis. Fourteen days later, she complained of sudden
headache and became
comatose. Computed tomography showed diffuse
subarachnoid hemorrhage. Angiography revealed a new right VA
dissecting aneurysm involving the posterior inferior cerebellar artery (
PICA). The orifice of the dissection was not apparent in the operative field and the dissection extended to the median. The patient underwent extracranial right VA
ligation, clipping of the proximal
PICA, and revascularization between the right occipital artery and distal
PICA. Her postoperative course was uneventful and she was discharged without neurological deficits. VA
dissecting aneurysms involving the
PICA without evident orifice or extending over the median can be treated by extracranial
ligation with clipping of the
PICA, followed by revascularization.