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Figure 3: A 56-year old female patient presented with acute-onset occipital headache. No cerebrospinal fluid evidence of xanthochromia was present. T1-weighted axial image (a) shows a focal T1 hyperintensity along the intradural segment of left VA – possibly an intramural hematoma. Magnetic resonance (MR) angiography (b) shows a focal fusiform dilatation in the same region. Selective injection of the left VA (c) confirms the dissecting aneurysm in the intradural segment of left VA with fusiform dilatation and differential opacification in the false lumen. Origin of the left PICA is involved in the aneurysm. Coil embolization was done in the aneurysm proximal to the left PICA origin (d) achieving complete antegrade occlusion and retrograde filling via the right VA. There is faint contrast opacification of the aneurysm and retrograde filling of the left PICA (e). Follow-up MR angiography at 3 months showed complete aneurysmal occlusion with a good signal in the left PICA via the contralateral codominant VA (f)

Figure 3: A 56-year old female patient presented with acute-onset occipital headache. No cerebrospinal fluid evidence of xanthochromia was present. T1-weighted axial image (a) shows a focal T1 hyperintensity along the intradural segment of left VA – possibly an intramural hematoma. Magnetic resonance (MR) angiography (b) shows a focal fusiform dilatation in the same region. Selective injection of the left VA (c) confirms the dissecting aneurysm in the intradural segment of left VA with fusiform dilatation and differential opacification in the false lumen. Origin of the left PICA is involved in the aneurysm. Coil embolization was done in the aneurysm proximal to the left PICA origin (d) achieving complete antegrade occlusion and retrograde filling via the right VA. There is faint contrast opacification of the aneurysm and retrograde filling of the left PICA (e). Follow-up MR angiography at 3 months showed complete aneurysmal occlusion with a good signal in the left PICA via the contralateral codominant VA (f)