These changes might be caused by local factors such as an increased intramural hematoma or extended intimal flap. Hemodynamic stress may also play an important role in repeated dissection, resulting in chronically enlarging dissecting aneurysms with multilayered intramural hematomas in some cases and extensive damage all targets to the internal elastic lamina [8].

A systemic factor, such as increased blood pressure might aggravate the natural course of the VBD. Both MRA and CT angiography offer potential advantages for noninvasive assessment of vascular disease, and they have been previously shown useful in the detection of VBD. Sequential neuroimaging examinations can indicate recanalization or normalization of the blood flow and thus are helpful for the decision to discontinue antithrombotic therapy, but the appropriate timing for follow-up examinations has not yet been defined [5]. In this case report, we showed that MRI and MRA are useful in evaluating an asymptomatic rapid progression of intracranial VBD. Our case suggests that intracranial VBD can progress

rapidly in a short time period, and those changes can be detected with MRI and MRA successfully.

Axial spondyloarthritis (AxSpA) is characterised by chronic inflammation of the spine and affects millions of people.1 Spondyloarthritis (SpA) has been classified into axial (AxSpA) and peripheral SpA depending on the major clinical presentation.2 3 Ankylosing spondylitis (AS) is the prototype AxSpA with characteristic radiographic changes in the sacroiliac joints. The disease starts predominantly

in young adults and in addition to chronic pain and disability, it causes significant morbidity and risk of mortality.4 AS poses a huge financial burden to the healthcare and public welfare systems by costing billions of dollars on treatment, disability and loss of productivity.5 6 The prevalence of AxSpA has been reported to be as high as that of rheumatoid arthritis, with estimates ranging from 1.0% Carfilzomib to 1.4%.7 Yet, until recently, AxSpA has received relatively less attention and is often overlooked in the initial stages due to the non-specific nature of the back pain.8 Large-scale studies of the incidence and prevalence of AS are scant. Studies examining epidemiological trends in AS have yielded variable results, some of which may be explained by differences in study design, geographic location, age, ethnicity, background prevalence of HLA-B27, genetic susceptibility and disease ascertainment.9–13 Some authors have reported AS incidence rates, but these studies were mainly in Europe.13–19 Documenting disease trends may improve our understanding of the pathogenesis of disease and aid in the planning of health services.