Vertigo secondary to isolated PICA insufficiency: Successful treatment with balloon angioplasty

BACKGROUND: The posterior inferior cerebellar arteries (PICA) arise from the intracranial segments of the vertebral artery (VA). We report a case where a nondominant isolated vertebral artery, which terminated in PICA, was stenotic. This resulted in brainstem-lower cerebellar ischemia, corrected with balloon angioplasty. CASE DESCRIPTION: A 62-year-old male presented primarily with transient vertigo, syncope, and dizziness and was diagnosed with transient ischemic attack. Angiography of the left vertebral artery (VA) demonstrated a small-caliber vessel terminating in PICA with a 90% stenosis at the C6 level. Angioplasty of the left VA was performed with excellent resolution of the stenosis. CONCLUSIONS: This case illustrates cerebellar insufficiency in a unique case where the PICA was isolated, supplied by a small- caliber VA. Correction of the stenosis improved the patient's symptomatology and prevented an inferior brainstem-cerebellar infarction.