Occlusion of the PICA was considered to be the primary cause of the dizziness. During the head rotation that induced dizziness, the right PICA was occluded, and a VA stenosis was revealed. The right PICA originated extracranially from the right VA at the atlas–axis level and ran vertically into the spinal canal. On radiographic examination, the bilateral VAs merged into the basilar artery, and the left VA was predominant. A 71-year-old man presented with reproducible dizziness on leftward head rotation, indicative of BHS. It has not been known to occur due to an extracranially originated posterior inferior cerebellar artery (PICA), the first case of which we present herein. Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Japanīow hunter's syndrome (BHS) is most commonly caused by compression of the vertebral artery (VA).It is not uncommon to observe monosodium urate deposits around this tendon 4 if the popliteus tendon appears abnormal in the context of no trauma, consider gout.Noriya Enomoto, Kenji Yagi *, Shunji Matsubara and Masaaki Uno Reconstruction has been described using biceps femoris tenodesis, split tendon transfer, as well as a posterolateral corner "sling" procedure which makes use of an extra-articular tendon graft to provide structural reinforcement between the posterior tibia and the anterior lateral femoral epicondyle 3. Primary repair techniques include the "recess procedure", which involves drilling a small tunnel at the site of osseous attachment and securing the ruptured tendon through the tunnel 3. In the event of popliteus tendon rupture and/or avulsion, both acute primary repair and delayed reconstruction of the popliteus have been advocated. Co-injury of the lateral collateral ligament is often addressed simultaneously as a multi-ligament reconstruction 3. Management of posterolateral corner injuries is variable, but knee instability is generally considered an indication for surgical intervention. Injury to the popliteus, especially in conjunction with injury to a lateral collateral ligament or posterolateral joint capsule, should raise suspicion for a posterolateral corner injury. complete tendon rupture or avulsion from the femur.increased intratendinous or myotendinous signal on fluid-sensitive sequences.The popliteus is only visualized clearly on MRI. In calcific tendinitis, the popliteus may become calcified 2. Usually, there is no specific x-ray finding of popliteus tendinopathy. Importantly, the posterolateral corner structures also affect the load experienced by the cruciate ligaments of the knee 3. These forces also result in posterolateral corner injury. injury to the posterolateral corner in combination with cruciate ligament injury results in more pronounced anterior or posterior instability.isolated injury to the posterolateral corner results in only slight anterior or mild posterior instability.popliteus and popliteofibular ligament are major stabilizers during knee flexion, whereas lateral collateral ligament is a major stabilizer in knee extension.varus stress (although less so than the lateral collateral ligament).The popliteus is often considered as a "popliteus complex", referring to its attachments: the popliteofibular ligament, popliteomeniscal fascicles (attaching to lateral meniscus), and its attachment to the posterior joint capsule 3.Īs a component of the posterolateral corner, the popliteus functions to resist 3: The popliteus tendon is located at the deepest portion of the lateral knee and is intimately associated with other structures which comprise the posterolateral corner. failure of anterior cruciate ligament graft, if unrecognized with initial injury.Given its typical injury mechanism, injury to the popliteus muscle may present with other symptoms of posterolateral corner injury, including: Pediatric injuries tend to involve avulsion fractures of the popliteus tendon from the femur 3. Traumatic popliteus injury has been described in both children and adults.