A case report of spontaneously healed isolated posterior inferior cerebellar artery dissection with headache alone

Abstract Background Isolated posterior inferior cerebellar artery dissections can cause subarachnoid hemorrhages or infarctions. Surgical treatments for hemorrhagic stroke cases and medical treatments using antithrombotic agents for ischemic stroke cases have been done, whereas there are very few reports on non-stroke posterior inferior cerebellar artery dissections and the treatment strategy for non-stroke cases has not been established. This is the first detailed report on spontaneously healed isolated posterior inferior cerebellar artery dissection with headache alone. Case presentation 48 years old healthy male felt severe right-side throbbing headache and came to OIKE Clinic on the fourth day after the onset. MRI studies revealed his right posterior inferior cerebellar artery dissection and showed no infarctions or hemorrhages. He was observed carefully under continuous monitoring of blood pressure and hydrated sufficiently, given analgesic anti-inflammatory agents. Two weeks later, the dissected vessel’s diameter grew up to the maximal size, though the patient’s headache was rapidly improved around that day. Surgical treatments for prevention of subarachnoid hemorrhage were considered but careful conservative therapy continued in accordance with the patient’s strong desire. Gradually the dissection finding had been improving. Four months later, MRI study showed his right posterior inferior cerebellar artery was seen almost normal in size and shape. Conclusions With the progress of high resolution MRI techniques, iPICAD will be detected more frequently. Further collection and assessment of iPICAD cases will lead to determine the optimal therapeutic strategy for iPICAD with headache alone.