Gold star world c 2 talos principle11/30/2023 ![]() ![]() Definite Portal vibes, but it does have its own personality, and it's own unique reason for being a test center. It's got a fresh mechanic (moving individual objects backwards and forwards along their timeline) that will create new wrinkles in your noodle, lovely art design, interesting story, fun writing, and good puzzle design. I really wanted to love 'Magrunner: Dark Pulse' but too much jank and frustrating puzzles like you mentioned-solving several mini puzzles in the right order. Honestly, only game I can think of that captured the Talos Principal's magic was Antichamber. Some of the expected ways to progress were crazy distant from each other too. I really enjoyed other games like 'The Witness' but wasn't able to solve the final handful of puzzles in the town for the ending. This game was mostly smooth and interesting through out. Not like some old mouse driven adventure/puzzle games where it felt like absolute luck that I progressed some puzzles and could not articulate what I did to progress. Game wasn't easy, but felt good to progress. There were some absolute tedious puzzles-any time you had to sneak past the sentries. Having to realize I could access a beam from another puzzle inside another puzzle by standing in a particular spot was in huge for solving some of those. But for the most part the game didn't include moon logic until you started doing the optional puzzles. A handful I got tried of and had to youtube how to progress specially with some of the weird solutions. The game did add quite a few of those at the end-soft multiple, small puzzles in a particular order to progress-typically when you had to get the colored beams through several doorways/windows by alternating which was pushing a switch at a given time. /r/GamePhysics - Clips of game physics shining and glitchingĭesign based on /r/FlatBlue created by /u/creesch./r/gaming4gamers - middle ground between purely-for-fun and more serious subreddits./r/GamingLeaksAndRumours - Leaks and Rumors.Posting unmarked spoilers will result in removal and warning, and posting spoilers with malicious intent will result in a ban. Please report posts containing spoilers unless they are hidden using the following method or are inside a thread clearly labeled as containing spoilers. If you want to promote without participating in the community, purchase an ad. For more information, see the self-promotion on reddit FAQ. Some promotional submitting (posting your own projects, articles, etc.) is permitted, but it must be balanced out by a much greater level of non-promotion participation in reddit - the rule of thumb is no more than 10% of your submissions may be promotional. Promotion must be kept within acceptable limits.Follow all specific content restrictions.No off-topic or low-effort content or comments.No personal attacks, witch hunts, bigotry, or inflammatory language.No content primarily for humor or entertainment.Questions likely to generate discussion.Shadow Gambit: The Cursed Crew Mimimi Games Want to schedule an AMA with us? Read our guidelines for more information! To see previous AMAs, click here. New to reddit? Click here! Subreddit Calendar Submissions should be for the purpose of informing or initiating a discussion, not just with the goal of entertaining viewers.įor examples of quality discussion posts we'd like to see in our subreddit, please review this page.įor an in-depth explanation of our rules, please review our rules page. The goal of /r/Games is to provide a place for informative and interesting gaming content and discussions. If you're looking for "lighter" gaming-related entertainment, try /r/gaming! Please look over our rules and FAQ before posting. r/Games is for informative and interesting gaming content and discussions. ![]()
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Minimalist daypack11/30/2023 ![]() ![]() Value is excellent: For just $80, you get a 3-liter quick-drying 3D Hydro reservoir (a $45 value), along with a lightweight 18-liter pack (available in both regular and plus sizes) that comes with a range of storage and features. What we don’t: Minimal support, capacity, and organization.įor short day hikes, multi-pitch rock climbing, or everyday travel, the Gregory Nano 18 H2O is a high-quality yet affordable offering from a company that knows how to make a solid pack. What we like: A versatile and affordable pack with 3 liters of water storage. See the Men's Osprey Skarab 30 See the Women's Osprey Skimmer 28īest Budget/Ultralight Hydration Pack 2. For an all-in-one solution that’s reasonably priced at $150, it doesn’t get much better-and Osprey offers the pack in three capacities to accommodate all your trail needs. ![]() But this is a pack that makes hydration (and everything else) easy-just fill up the premium Osprey Hydraulics LT reservoir, slide it into its pouch behind the backpanel, and hook up the quick-disconnect hose, which routes cleanly through a port and secures via a magnet onto the sternum strap. We do have a few small gripes: The hipbelt pockets (one zippered, one stretch mesh) don’t accommodate our standard-sized smartphone, and both the Skarab and Skimmer only come in one torso size. For the standard day hike, many of these packs are too big or too small, too overbuilt or too streamlined on the other hand, when we put on the Skarab, it was just right. You can go a lot of directions with a hydration pack: Our picks below run the gamut from uber-featured and supportive rigs to stripped-down vests for fast and light endeavors. We’ve tested a lot of hydration packs, and in our opinion the Skarab is the most well-rounded design for day hikers. The 30-liter version can easily accommodate a down jacket and shell, snacks for the day, and other essentials, and organization and on-the-go access is well thought-out and convenient. Our favorite goldilocks model is the Osprey Skarab 30 (and women’s Skimmer 28): In addition to the spacious main compartment with large bucket-style opening, you get a premium 2.5-liter reservoir, a generously sized accessory pocket, hipbelt pockets, and a front dump pocket for stashing extra layers. There’s no shortage of hydration packs to choose from, but most hikers will benefit from a simple yet functional design that offers ample gear and water storage, a nicely cushioned yet low-profile suspension system, and convenient organization. What we don’t: Hipbelt pockets are too small only comes in one size. What we like: An ideal combination of storage, convenience, and comfort. Best Hydration Pack with On-the-Go Storage: REI Co-op Flash 15 Hydration Vestīest Overall Hydration Pack for Hiking 1.Most Comfortable Hydration Pack for Heavy Loads: Osprey Manta 34 / Mira 32.Best Budget/Ultralight Hydration Pack: Gregory Nano 18 H2O.Best Overall Hydration Pack for Hiking: Osprey Skarab 30 / Skimmer 28.For more information, see our buying advice and comparison table below the picks. Below we break down our favorite hiking hydration packs of 2023, from minimalist vest-inspired models to feature-rich designs that can even accommodate an overnight load. ![]() An all-in-one system that includes a sleekly paired daypack and hydration reservoir, a hydration pack makes loading, carrying, and accessing water a breeze. There are a number of ways to ensure that you drink enough water throughout the day, but by far the most convenient is a hydration pack. ![]() No matter the length or location of your hike, hydration is one of the keys to staying happy and healthy on the trail. ![]() Turning fractions into whole numbers11/30/2023 ![]() Revision notes and formula sheets are shared with you, for grasping the toughest concepts. WAVE platform encourages your Online engagement with the Master Teachers. We provide you year-long structured coaching classes for CBSE and ICSE Board & JEE and NEET entrance exam preparation at affordable tuition fees, with an exclusive session for clearing doubts, ensuring that neither you nor the topics remain unattended. We have grown leaps and bounds to be the best Online Tuition Website in India with immensely talented Vedantu Master Teachers, from the most reputed institutions. Vedantu LIVE Online Master Classes is an incredibly personalized tutoring platform for you, while you are staying at your home. ![]() If there is a remainder after dividing the numerator and denominator, the fraction cannot be expanded into a whole number. A fraction can only be expressed as a whole number when the numerator is a multiple of the denominator. Some improper fractions can be transformed into whole numbers. However, the majority of improper fractions are transformed into mixed numbers with a remainder. We turn the fraction into an operational version of the mathematical expression in order to deal with expressions such as those that are improper. The set of whole numbers in Mathematics is given as $ into a mixed number. Whole numbers are part of real numbers including all the positive integers and zero, but not fractions, decimals, or negative numbers. We know that natural numbers refer to a set of counting numbers starting from 1, 2, 3, 4, and so on. Natural numbers along with zero (0) are referred to as whole numbers. In the section on converting fractions, we'll go through how to convert improper fractions to whole or mixed numbers, improper fractions to mixed numbers, and whole numbers to improper fractions. Derived from the original Latin word 'Fractus,' the term ‘fraction’ means broken. ![]() The number on the top is known as the ‘numerator’, and the number below is known as the ‘denominator’. It is shown in the form of '/', as in, a/b. Fractions represent any number of equal parts in a whole number. ![]() Fire emblem engage bow knight11/30/2023 ![]() In Fates, the Bow Knight class is treated as a Nohrian class, acting as one of the promoted forms of both the Mercenary and Outlaw classes. This incarnation of the class is able to wield Swords alongside Bows, drawing inspiration from the Nomadic Trooper from The Binding Bladeand The Blazing Blade, alongside the Ranger class from The Sacred Stones. In Awakening, the Bow Knight class is one of the possible promoted forms of both the Archer and Mercenary classes. In Radiant Dawn, the Bow Knight class can further promote into the Silver Knight class after promoting into the Bow Paladin class. In the Tellius Series, Bow Knights are a first-tier class that promotes into either Paladins in Path of Radiance or Bow Paladins in Radiant Dawn. In TearRing Saga: Utna Heroes Saga, the Bow Knight class is known as the Bow Rider, translated Ranger in the fan translation) and is an enemy-exclusive mounted class which can equip bows only. There are no recruitable pre-promoted units of this class in either title. In the Jugdral Series, the Bow Knight class is the promoted form of the Arch Knight class. In the DLC for Echoes, the Bow Knight can further promote into their Overclass, the Oliphantier. ![]() They are renowned for being especially useful for attacking most enemies without retaliation or when a unit requires protection due to their ability to hit enemy units from a considerable distance. ![]() In Gaiden and its remake Echoes: Shadows of Valentia, the Bow Knight class is the third-tier promotion of the Archer class family, possessing an attack range of 1~5.
Chaumont bay contour map11/30/2023 ![]() Carp can be seen along the Long Bay portion of the park, and bass can be seen spawning underneath the dock system at the Long Point Marina in spring. There are plenty of popular fish in the area, including walleye, small- and largemouth bass, yellow perch, crappie, bullheads, northern pike, and channel catfish.Minks will also take up residence in the rocky limestone shoreline banks. ![]() These include blue herons, common and artic terns, buffleheads, common golden eyes, loons, and the occasional broadbill. With Long Point being surrounded by shoreline, many water birds use and take shelter in the park.As a remote 23 acre park on Point Peninsula, Long Point provides excellent access to this bay. Chaumont Bay is a large fresh water bay off of Eastern Lake Ontario.*Additional $5/night for non-NYS residents Learn more about our Admission Programs including the Empire Pass. Purchase online or contact your favorite park for more information. of Environmental Conservation including forests, beaches, trails and more. The easy-to-use Empire Pass card is $80- and your key to all-season enjoyment with unlimited day-use entry at most facilities operated by State Parks and the State Dept. For fees not listed or to verify information, please contact the park directly. A list of entry fees and other park use fees is available below. Most New York State Parks charge a vehicle use fee to enter the facility. Pets are not permitted in playgrounds, buildings, golf courses, boardwalks, pools and spray-grounds or guarded beaches (this does not apply to service animals). Proof of rabies inoculation shall be produced if requested by staff. Pets are to be supervised at all times and either be crated or on a leash not more than 6-feet in length. Pet Policy: A maximum of two pets are allowed in campsites and day use areas unless prohibited by sign or directive. Constant lake breezes keep the park cool and mosquito-free. The bay provides a protected harbor for boats, and Lake Ontario offers excellent boating and fishing opportunities. Campsites are fairly open and grass-covered with scattered trees, a playground and picnic areas. Situated on a peninsula facing Chaumont Bay on Lake Ontario, the park is small and almost completely surrounded by water with great views from anywhere in the park. Long Point State Park is in a remote area, offering a peaceful, relaxing camping experience. See a full listing of DEC's Accessible Recreation Destinations.A maximum of two pets are allowed in campsites and day use areas unless prohibited by sign or directive. Contact your local DEC office for additional details. Some sites on larger waters also have accessible boarding docks. Parking, as well as other amenities such as bathrooms and informational kiosks, are also accessible. Sites are accessible to the top of the boat ramp, if provided at a site. Other IconsĪccessible Features - Locations are identified above. Boat may then be pushed on or off trailer. Sites will accommodate the approach to the water's edge of small and light trailered boats. Unimproved trailer launch - No float-off or float-on trailered boat capability. Hard surface launch - Site affords float-off and float-on launching for most trailered boats. Use the following definitions to help you determine if a particular site will accommodate your boat: Other invasive species may also be present. 44.375795°N, 75.859145°W ( Google Maps)Įurasian Watermilfoil, European Frogbit, Starry Stonewort, Curly-leaf Pondweed, Zebra Mussel, Spiny Waterflea 43.710084°N, 76.182183°W ( Google Maps)Įurasian Watermilfoil, Curly-leaf Pondweed, Zebra MusselĪccessible fishing pier/bulkhead available (including shore fishing and floating dock) Once the shoreline is repaired it will be accessible again. Note: The shore fishing area was damaged by flooding. Lake Ontario (Black River Bay at Perch River) Lake Ontario (Black River Bay at Muskellunge Creek) Lake Ontario (Black River Bay at Lloyds Landing) 44.005992°N, 76.040574°W ( Google Maps)Įurasian Watermilfoil, Curly-leaf Pondweed, Zebra Mussel, Spiny Waterflea, Fishhook Waterflea ![]() Jefferson County, DEC Region 6 Waterbodyįish Island Park. For an explanation of the recreational icons on this page, see below. ![]() Openvpn auto connect windows 1011/30/2023 ![]() ![]() You will see a list of configuration options, some of which have to be changed. So, instead of the subfolder config, go, first, to the subfolder sample-config, and open client.ovpn in any editor, such as Notepad (note that if you did not uncheck OpenVPN File Associations during installation, then double clicking this file will open it with OpenVPN, not in Notepad, so that in this case instead you need to right click the file and choose Open with. We will talk about running OpenVPN as a service later, but for now we need to create a configuration file in this directory. Process will be instantiated for each configuration file. When OpenVPN is started as a service, a separate OpenVPN By default, there is only one file README in the directory, which says the following: This directory should contain OpenVPN configuration files The installation directory (usually C:\Program Files\OpenVPN\) has a subfolder named config. If you right click the icon now, you won't see anything interesting now, except for Settings and Exit menus. If at the last step of the installation wizard you opted to start OpenVPN GUI immediately, you should see an icon in the system tray that looks like a grey monitor with an unlocked lock (this icon may be hidden in the collapsable tray by default). I usually uncheck OpenVPN File Associations as they are not needed. Some options, such as OpenVPN File Associations, OpenVPN Utilities and OpenVPN RSA Certificate Management Scripts, are optional. On the "Select components to install" page MAKE SURE that OpenVPN Service, TAP Virtual Ethernet Adapter and OpenVPN GUI are selected. For example, for 64-bit Windows 10 you may want to download the link that contains openvpn-install-x.x.x-I601-x86_64.exe in its name. Follow the link that is most appropriate for your system. At the time of this writing, for example, you may have ended up at or, but they both contain the same links. It may lead to several different webpages, but they all seem to provide the same downloads. The best option is to search for "OpenVPN community downloads" and follow the (usually first) link found. The downloads for open source OpenVPN clients are somewhat hidden on their website. More importantly, it shows how to ensure that the Windows OpenVPN client starts automatically when the computer is connected to the server running OpenVPN. Then uncheck “ Stop the task if it runs longer than” option.This short article describes how to install and connect Windows OpenVPN client to a server that runs OpenVPN. In the “ Settings” tab check “ Allow task to be run on demand”. In the “ Conditions” tab uncheck options “ Start the task only if the computer idle for” and “ Start the task only if the computer on AC power”. Go to the “ Triggers” and edit the “ At log on trigger”. You should use the name of your config file.Ĭheck “ Open the Properties dialog for this task when I click Finish” option.Īt the “ General” properties tab check “ Run with highest privileges” option. –connect “str-XXXXXX_sXXXXXX_account.ovpn”ĭo not use “str-XXXXXX_sXXXXXX” this is just an example. ![]() In the “ Program/script” field type the full path to your OpenVPN GUI executable or click browse and select it from the folder you have it installed. Now in “ Action” select “ Start a program”. For example “ OpenVPN autostart” (without quotes). The name of the task can be any you like. In the “ Actions” column, click the “ Create Basic Task…”. In the appeared window write down “ taskschd.msc” (without quotes). (Win is the key with Windows logo on it, R is letter “R”). If the steps above do not work, you can try this way: Step 1 Restart your computer and check if the OpenVPN has connected.Īlternative way of setting up autoconnect for OpenVPN GUI Scroll the Services list to find “ OpenVPN Service”. In the appeared window write down “ services.msc” (without quotes). It is located below all the steps.Īfter setup, please make sure that your OpenVPN connection is working (connect it and then disconnect). You can find the instructions how to save login and password in each tutorial for any OS in the section “ Saving the login and password for the OpenVPN GUI”. If you are using our new OpenVPN servers (basically if your config file name starts with “ str” letters), you need to make sure that you will be not asked for login and password on every connection attempt. If not, you can find Manual Setup Tutorial depending on your OS there: Manual Setup section. This tutorial was made on Windows 10, but it is tested and compatible for Windows XP, Vista, 7 and 8 as well.īefore you start make sure that you have already set up OpenVPN connection. ![]() I need you bible verse11/30/2023 ![]() Psalm 1:1-3 Blessed is the one who does not walk in step with the wicked or stand in the way that sinners take or sit in the company of mockers, but whose delight is in the law of the Lord, and who meditates on his law day and night.Philippians 4:19 And my God will meet all your needs according to the riches of his glory in Christ Jesus.James 1:17 Every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like shifting shadows.At the start of a new year, these Bible verses help us remember that every good gift comes from God our Heavenly Father. There’s lots of wisdom about blessings in the Bible. For I am going to do something in your days that you would not believe, even if you were told. Habakkuk 1:5 Look at the nations and watch - and be utterly amazed.He will take great delight in you in his love he will no longer rebuke you, but will rejoice over you with singing. Zephaniah 3:17 The Lord your God is with you, the Mighty Warrior who saves.1 Peter 1:3 Praise be to the God and Father of our Lord Jesus Christ! In his great mercy he has given us new birth into a living hope through the resurrection of Jesus Christ from the dead.Psalm 65:11 You crown the year with your bounty, and your carts overflow with abundance.But one thing I do: Forgetting what is behind and straining toward what is ahead, 14 I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus. Philippians 3:13-14 Brothers and sisters, I do not consider myself yet to have taken hold of it.Psalm 90:12 Teach us to number our days, that we may gain a heart of wisdom.They will soar on wings like eagles they will run and not grow weary, they will walk and not be faint. Isaiah 40:31 But those who hope in the Lord will renew their strength.Perhaps pick out a message that brings you hope and share with a friend. ![]() ![]() Take a moment to reflect on the truths of God’s word. We’ve gathered together our favourite new year verses to remind you that God will be with you, no matter what lies ahead. Our favourite new year Christian messages Whatever you’re feeling as we start 2023, we hope this collection of new year Bible verses will encourage you to face the year with hope.Īll these Bible verses for the new year are taken from the NIV version of the Bible. The start of a new year can be exciting and overwhelming, especially during these uncertain times. ![]() Elephant leather hides11/30/2023 ![]() PMK Customs does work with the Nike brand (and others) as well, but neither Nike nor any other brand has a say in how the shoes are altered. The sneakers were designed by PMK Customs (a high-end sneaker customization company originally called "Pimp My Kicks") and made from an Air Jordan 1, which was then retrofitted with several different animal skins. The shoes, dubbed the " Brooklyn Zoos," feature elephant, stingray, lizard, crocodile, ostrich hides, and can fetch up to $20,000. This shoe, however, was not created by Nike. A recent BBC report into the "super-rich's insatiable appetite for luxury goods" highlighted a sneaker that really was made with the hide of an elephant: On 28 April 2016, Facebook user Jason Gunn Burton, who originally posted the "Just Boycott It" message, added some additional information about Nike's alleged elephant skin shoes. Providing leather hides, scrap leather, tools, hardware, and supplies to leather crafters, large and small. Pink remnants on the sides are what's left from the Swoosh logos that used to adorn the sides. The Leather Guy is the 1 Online Leather Supplier. The elephant was fitted for the shoe using lifts. To help the elephant find its balance, Nike manufactured this massive leather shoe, complete with laces and buckles at the heel. Elephant Embossed Calfskin Leather Hides, with a soft temper, suitable for leather goods, bags, suitcases, saddlery belts and shoes. It can have 6 credit card slots or 8 credit card slots. Some places in Africa have culled elephant products which, with a CITES permit, the hides may be purchased and resold. It is stitched with heavy duty nylon thread that matches the color of the leather. While ivory is obviously illegal, elephant leather is legal if the animal was 'culled' as opposed to poached. It is one of the toughest leathers we offer. If so, tell us about your experience in the comments section below.Several years ago, Nike learned of an elephant that had one leg shorter than the others. 94.99 Quantity Add to Cart This wallet is made with beautiful authentic African Elephant leather that is tanned gray. What do you think? Do you like the look of elephant leather? Have you worked with it before. ![]() The picture below is of a car that sports an elephant/stingray car interior. Personally, I can’t wait for the fad of exotic hides to pass – especially the combining of different animal skins. Generally, elephant hides are very wrinkled, which is a positive way to tell them apart from false hides. We deal with reputable international partners who abide by all regulations and we never sell poached hides. Ruby Red Dyed Veg Tan, 4 - 6 Sq Ft, 2-3 oz Kangaroo Hides. Burnt Brush Black, 4-5 oz, 1-4 Sq Ft, Genuine Elephant Hides. Savanna Storm Dark Grey, 4-5 oz, 1-4 Sq Ft, Genuine Elephant Hides. Designers, manufactures, and leather enthusiasts should not feel emotional or have guilt for using this leather as we are not creating a demand rather using a by product. Kangaroo Natural Veg Tanned 4 - 8 Sq Ft Hides 2-3 oz. Without culling, often viewed as unethical, many African tribes would loose their homes and possibly become trampled to death. It’s very similar to our deer season in the United States. The source of all African elephant skins come from culls once the elephant herd reaches destructive numbers to African tribes and nature. The hides, of course, are procured legally. The high price is attributed to the fact that African elephants are an endangered species. Rojé Exotics, a popular supplier of elephant leather, sells the skin for $40 per square foot, and requires a minimum purchase of eight square feet. ![]() If you are going to order elephant leather, shop around because it’s expensive. In fact, I liken the look and feel of elephant leather to cow hides that have been left in the sun for too long. But to each his own, right? While some folks are drawn to the large patterns in the skin, others – like me – think it looks cracked. The skin’s deep grains and course, rippled texture is definitely unique – just not for everyone. Our quality Elephant Leather is from African, authentic Elephant Belt & Wallets. Popular elephant print leather embossed cow leather hides for shoes 2.50 - 3.00. These genuine leather are perfect for clothing, upholstery and more. If you’ve got customers with deep pockets and a taste for the exotic, consider offering elephant leather. Exotic Elephant leather, itis thick and durable with a course, rippled texture. Use the resources of to find the perfect shipment of wholesale elephant leather for your customers. ![]() Wondershare whatsapp transfer torrent11/30/2023 ![]() ![]()
Pica artery surgery11/30/2023 ![]() 1), was located below the foramen magnum on the ascending part of the PICA. 1), and the pseudoaneurysm, extracranial but intradural (fig. ![]() The origin of the PICA was extradural at the level of the first cervical vertebra (fig. Cerebral angiography revealed a 6-mm-large dissecting aneurysm of the right PICA. Computed tomography (CT) scanning showed SAH predominating in the posterior fossa. Hospitalized few hours later, she did not present any neurological deficit but a very intense headache and mild neck stiffness. is a 40-year-old woman who experienced a sudden headache during a sexual relation, and then she lost consciousness for a while. The long-term clinical results depend mainly on the clinical status on admission. In the group of patients presenting SAH, endovascular treatment was safe and effective. The treatment depends on the existence of a hemorrhagic event. Conclusion: Clinical course and prognosis are variable in PICA dissections. A good recovery was achieved for 4 patients (modified Rankin Score 0) one patient who presented SAH and who was in bad clinical state on admission had a Glasgow Outcome Score of 3 and a modified Rankin Score of 4 three years later. ![]() We assessed the long-term results with the Glasgow Outcome Score and the modified Rankin Score. The angiographic and clinical follow-up lasted more than 3 years. Three patients presented acute hydrocephalus and were treated with surgical derivation. No ischemic complication and no rebleeding were observed after sacrifice of the PICA. The others presented subarachnoid hemorrhage (SAH) and were treated by embolization (endovascular sacrifice of the PICA). One patient presented ischemic manifestations he was treated with heparin. The diagnosis was carried out by cerebral angiography in all the cases: in 4, angiography showed focal stenosis with saccular or fusiform dilatation of the artery at the site of the dissection in 1 a double lumen aspect was described. No predisposing factor or traumatic cause was described in the other cases. Two patients presented symptoms after cervical manipulation. Methods and Results: From 1999 to 2003, five patients (40–71 years old) were hospitalized for PICA dissection. The aim of the study was to investigate the clinical manifestations, the neuroradiological aspects and the treatment of 5 cases collected in 5 years. Therefore, we decided on a conservative management with antiplatelet therapy and planned for a follow- up TFCA 2 weeks later.Background and Purpose: Spontaneous isolated posteroinferior cerebellar artery (PICA) dissection is very rare. Since 10 days had passed after dissection, a procedure-related risk from stent insertion or stent-assisted coil embolization was thought to be larger than a rupture risk. The follow-up TFCA 1 week later showed no change of stenosis of the right proximal PICA, but an additional finding of a pre-stenotic fusiform dilatation (3 x 4 mm) of the right proximal PICA was newly observed ( Fig. ![]() The origin of PICA was extracranial and dissection occurred at the lateral medullary segment of PICA, which was intradural. ![]() The transfemoral cerebral angiography (TFCA), performed 4 days after the onset of symptoms showed an abrupt segmental stenosis of the right proximal PICA, which is suggestive of dissection ( Fig. The magnetic resonance angiography (MRA) showed an abrupt luminal stenosis and subtle dilatation of the proximal segment of the right PICA, suggestive of possible dissection ( Fig. The brain magnetic resonance imaging (MRI) was performed 2 days after the onset of symptoms and showed an acute infarction in the right lateral medulla ( Fig. ![]() AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |