Case 1

Acute presentation. Partially thrombosed fusiform intradural vertebral artery aneurysm

nothing from aneurysm here

or here

Ohh..  Big one.  How easy is this to miss…  This is why vert sacrifices “inexplicably” leads to Wallenbergs in the literature.  Just look carefully, and the mystery vanishes.  Its a big lateral medullary perforator.  More often present when the PICA is either C1 or high — in other words, not arising from the proximal intradural segment. See vert page for more details.

Both vermian and lateral medullary supply.  Again, just look carefully…

Another case — acute presentation

nothing to see here?

Or here

How about here? Another big one…  Also appreciate the heretofore not so obvious acute dissection morphology. Proximal stenosis, false lumen dilatation…

Amazing video of vasa vasorum in the dissected segment — visible due to hematoma separation between the wall and the lumen

PEDs

6 mo post

See vertebral artery, PICA, and lateral spinal artery pages for more info on how to avoid that Wallenberg

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