Three-dimensional visualization of vertebrobasilar system aneurysms in a vertigo patient

Cerebral artery fenestration refers to a division in the lumen of an artery leading to two distinct endothelium-lined channels. At the site of turbulent flow, fenestration may predispose to an aneurysm formation. In this study, a 45-year-old woman suffered an acute vertiginous attack after cervical manipulation. The MRI scan demonstrated basilar artery duplication and tortuous left distal vertebral artery impinging on the cisternal segment of the cochleovestibular nerve. Subsequent three-dimensional (3D) reconstruction by MR imaging showed vertebrobasilar artery fenestrations with aneurysms. Unfortunately, subarachnoid hemorrhage occurred 6 days later, and the patient became comatose one year after presentation. In summary, subarachnoid hemorrhage caused by vertebrobasilar system aneurysms is a life-threatening event. Delineating the configuration by 3D-reconstruction of MR images allows more accurate diagnosis and more effective management.