Abstract
An 85-year-old woman came to our hospital due to an inability to live independently from a decline in her activities of daily living. Neurologically, she showed no focal signs, but multiple acute ischemic lesions were evident in the posterior circulation on magnetic resonance imaging. Occlusion of the right intracranial vertebral artery (VA) and stenosis of the left intracranial VA were detected on magnetic resonance angiography (MRA). Carotid duplex ultrasonography (CUS) showed a flow pattern with occlusion of the right VA before the branching of the posterior inferior cerebellar artery. Based upon antegrade flow in the right intracranial VA as evaluated on transcranial color flow imaging, the distal VA territory might have been maintained via collateral flow. With antiplatelet therapy and intravenous injection of argatroban, the patient’s activity gradually improved to the same level as before admission. Recanalization of the right VA was seen on MRA and CUS at 14 days after admission. Reduced cerebellar blood flow due to VA occlusion was thought to be associated with the mechanism affecting her activity levels. Follow-up ultrasonography was useful for evaluating changes in intracranial hemodynamics in this patient who demonstrated neurological improvement.
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