Long-term Observation of Lateral Medullary Infarction due to Vertebral Artery Dissection Assessed with Multimodal Neuroimaging

A 33-year-old man presented with a lateral medullary infarction, vertigo, and nausea. At the time of hospital admission, he had Wallenberg syndrome. Although initial magnetic resonance imaging showed no abnormalities, subsequent diffusion-weighted magnetic resonance imaging showed a high-intensity area in the right lateral medulla oblongata. The right vertebral artery was shown to be dilated on basi- parallel anatomical scanning but to be stenosed on magnetic resonance angiography (MRA). Cerebral angiography 7 days after onset showed the "pearl and string sign" in the right vertebral artery. Follow- up MRA showed gradual improvement of the stenosis in the right vertebral artery. Multiple neuroimag- ing studies, such as MRA, basi-parallel anatomical scanning, 3-dimensional computed tomographic an- giography, and cerebral angiography, should be performed soon after onset in suspected cases of cere- bral artery dissection. In addition, serial imaging examinations increase diagnostic accuracy, and the medical history and neurological examination are important. (J Nippon Med Sch 2015; 82: 68―72)