And this case is classified as a Yonas type 2 (type 2 occurs within the media or adventitia and tends to present with hemorrhage). In this case, pathological findings showed the internal elastic lamina was folded, the true lumen was torn by the false lumen, and the dissection reached adventitia ( Fig. 1, 4, 5, 10, 11) However, conservative treatment might be chosen for non-hemorrhagic lesion in consideration of spontaneous healing. Surgical treatment is generally recommended for hemorrhagic lesion and non-hemorrhagic lesion with expansion of the DA. One case (14.3%) was died in 7 cases including SAH which were treated by conservative treatment. Subarachnoid hemorrhage (SAH) was major type of diseases (65.1%). The mean age was 47.8 years (ranging from 22 to 71), 61.9% (39 patients) were male, and 58.7% (37 cases) were left side lesion. Review of the cases showed 63 dissecting PICA aneurysms. That kind of sounds may help the diagnosis of the DA. This patient complained of sounds like broken balloons. It is not possible to diagnose the DA without suspecting a DA, although MRI is also spread widely. Pathological findings might help understanding the etiology of DAs and inflammation might play an important role in DAs. The dissection reached the adventitia and the wall had numerous macrophages. Pathological findings showed folding of the internal elastic lamina, and the true lumen was torn by the false lumen. The surgery was performed without complication. This DA aneurysm was trapped and removed after an occipital artery (OA)-PICA anastomosis was performed. Therefore, surgery was performed to prevent aneurysmal rupture. Magnetic resonance angiography (MRA) showed growth of the DA 12 days after the onset of headache. MRI revealed no hemorrhage or infarction. A 44-year-old man with an unruptured DA of the left PICA presented with sudden left occipital headache. This is the first report regarding the pathology of an intact DA of the PICA that presents with headache only, and the pathological findings showed interesting figures. However, the treatment of an unruptured DA with headache or infarction has not been well established. Generally, surgical treatment might be considered in cases of DA with hemorrhage. Because of the wide spread of magnetic resonance image (MRI), it may be increasing to find a dissecting aneurysm (DA) of the posterior inferior cerebellar artery (PICA) that causes headache without associated hemorrhage or infarction.
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