Absent right PICA

Case contributed by Dr Yair Glick

Presentation

Suspected cerebral infarction.

Patient Data

Age: 60 years
Gender: Male
CT

No evidence of recent infarction or hemorrhage (CT brain not shown).

Incidentally noted absence of right posterior inferior cerebellar artery (PICA). Well-developed left PICA.

Case Discussion

Unilateral absence of the PICA is common 1,2. The differential diagnosis for an absent PICA is PICA occlusion and a hypoplastic PICA. In this specific case, there was no clinical suspicion nor imaging evidence of a PICA territory cerebellar infarction (PICA occlusion), nor was there any sign of origin of the artery (hypoplastic PICA). A sign that strengthens the diagnosis of an absent PICA is the well-developed contralateral PICA 1. If the rest of the PICA's course is visible (see PICA -Segments), look for an anomalous origin - it may originate from the basilar artery 2.

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