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Click 36 year old female with dissecting pseudoaneurysm of the right vertebral artery terminating in the posterior inferior cerebellar artery (PICA) indistinguishable from a brain vascular anomaly (pial or dural arteriovenous malformation) by non invasive imaging. Non contrast head CT through the posterior fossa up to the level of the midbrain demonstrating acute subarachnoid hemorrhage with a focal hyperdensity at the craniocervical junction. Intra-ventricular hemorrhage is identified within the fourth ventricle. Diffuse cerebral edema is noted with effacement of basal cisternal spaces.

Click 36 year old female with dissecting pseudoaneurysm of the right vertebral artery terminating in the posterior inferior cerebellar artery (PICA) indistinguishable from a brain vascular anomaly (pial or dural arteriovenous malformation) by non invasive imaging. Coronal frontal maximum intensity projection contrast enhanced CT angiogram (CTA) of the head and neck imaged in the arterial phase through the craniocervical junction demonstrates what was initially presumed to be an intranidal arteriovenous malformation aneurysm.

Click 36 year old female with dissecting pseudoaneurysm of the right vertebral artery terminating in the posterior inferior cerebellar artery (PICA) indistinguishable from a brain vascular anomaly (pial or dural arteriovenous malformation) by non invasive imaging. Right vertebral artery injection diagnostic catheter angiography frontal view during the arterial phase demonstrates an abrupt change in the caliber of distal right vertebral artery with segmental narrowing of the intra-cranial vertebral artery in conjunction with a solitary broad neck dissecting pseudoaneurysm. A posterior inferior cerebellar artery is identified without early arteriovenous shunting. Early capillary phase) revealing a vertebral artery terminating in the PICA (posterior inferior cerebellar artery) without identification of an early draining vein that is characteristic of an arteriovenous malformation (AVM). Late capillary, early venous phase angiography identifies expected venous drainage from the right PICA cerebellar vascular territory. Concordant venous drainage with the remaining brain venous outflow during the angiographic venous phase.

Click 36 year old female with dissecting pseudoaneurysm of the right vertebral artery terminating in the posterior inferior cerebellar artery (PICA) indistinguishable from a brain vascular anomaly (pial or dural arteriovenous malformation) by non invasive imaging. Post-embolization non contrast axial head CT images through the posterior fossa show artifact from the NBCA embolysate (arrow). Low attenuation from PICA territory infarction and effacement of the fourth ventricle.

Click 36 year old female with dissecting pseudoaneurysm of the right vertebral artery terminating in the posterior inferior cerebellar artery (PICA) indistinguishable from a brain vascular anomaly (pial or dural arteriovenous malformation) by non invasive imaging. Selected axial non contrast CT head images after decompressive craniectomy and resolved mass effect on the fourth ventricle.