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Posterior cerebral artery (PCA) dissection is rarely experienced, and therefore the treatment of this disease is still controversial. We report here 5 cases, and review the literature to clarify their therapeutic and prognostic aspects. In our group of 5 patients, 1 presented with repetitive subarachnoid hemorrhage (SAH) treated surgically by proximal ligation at the P1 segment. The other cases—2 patients with ischemia, 1 with SAH, and 1 incidental case—were treated conservatively. Over a mean follow-up period of 73 months, all patients remain independent. Three patients showed no neurological deficit and 2 showed mild disability. Angiography showed that 3 symptomatic patients had spontaneous resolution of the dissection. However, 1 patient treated with proximal ligation showed a recurrence of the dissecting aneurysm at the P2 segment via the posterior communicating artery. In our analysis of 53 cases with PCA dissection (including 48 previously reported cases), 21 patients presented with ischemic events and 19 had SAH. Nineteen of the 21 ischemic cases were treated conservatively and all showed good clinical outcomes. The remaining 2 ischemic cases were treated with endovascular surgery and showed good outcomes. Eleven of the 19 SAH cases were treated conservatively and all but 1 had good outcomes. The other 8 SAH cases included 5 patients with endovascular surgery were treated surgically and also showed good results. Conservative treatment with careful monitoring using neuroimaging modalities should be considered when a patient presents with a neurologically and morphologically stable condition.

A Clinical Analysis of Posterior Cerebral Artery Dissection with Special Reference to Management and Outcome