1
|
Tarsia J, Vidal G, Zweifler RM. Arterial Dissection, Fibromuscular Dysplasia, and Carotid Webs. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
2
|
Kim SH, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG. Acute Pontine Infarction due to Basilar Artery Dissection from Strenuous Physical Effort: One from Sexual Intercourse and Another from Defecation. J Cerebrovasc Endovasc Neurosurg 2016; 18:100-105. [PMID: 27790399 PMCID: PMC5081493 DOI: 10.7461/jcen.2016.18.2.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/30/2016] [Accepted: 06/11/2016] [Indexed: 11/23/2022] Open
Abstract
A basilar artery dissection (BAD) is an extremely rare disease. It can lead to hemorrhage or infarction involving the brain stem, and is often associated with grave outcome. However, little is known about the pathophysiology of BAD, and its proper managements are yet in controversy. Herein, we report on two rare cases of basilar artery dissection from strenuous physical effort; one from sexual intercourse and another from defecation. The treatment modalities and the outcomes are also discussed.
Collapse
Affiliation(s)
- Su-Ho Kim
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon-Soo Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sang-Jun Suh
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jeong-Ho Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Kee-Young Ryu
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dong-Gee Kang
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| |
Collapse
|
3
|
Tarantini S, Giles CB, Wren JD, Ashpole NM, Valcarcel-Ares MN, Wei JY, Sonntag WE, Ungvari Z, Csiszar A. IGF-1 deficiency in a critical period early in life influences the vascular aging phenotype in mice by altering miRNA-mediated post-transcriptional gene regulation: implications for the developmental origins of health and disease hypothesis. AGE (DORDRECHT, NETHERLANDS) 2016; 38:239-258. [PMID: 27566308 PMCID: PMC5061677 DOI: 10.1007/s11357-016-9943-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
Epidemiological findings support the concept of Developmental Origins of Health and Disease, suggesting that early-life hormonal influences during a sensitive period of development have a fundamental impact on vascular health later in life. The endocrine changes that occur during development are highly conserved across mammalian species and include dramatic increases in circulating IGF-1 levels during adolescence. The present study was designed to characterize the effect of developmental IGF-1 deficiency on the vascular aging phenotype. To achieve that goal, early-onset endocrine IGF-1 deficiency was induced in mice by knockdown of IGF-1 in the liver using Cre-lox technology (Igf1 f/f mice crossed with mice expressing albumin-driven Cre recombinase). This model exhibits low-circulating IGF-1 levels during the peripubertal phase of development, which is critical for the biology of aging. Due to the emergence of miRNAs as important regulators of the vascular aging phenotype, the effect of early-life IGF-1 deficiency on miRNA expression profile in the aorta was examined in animals at 27 months of age. We found that developmental IGF-1 deficiency elicits persisting late-life changes in miRNA expression in the vasculature, which significantly differed from those in mice with adult-onset IGF-1 deficiency (TBG-Cre-AAV8-mediated knockdown of IGF-1 at 5 month of age in Igf1 f/f mice). Using a novel computational approach, we identified miRNA target genes that are co-expressed with IGF-1 and associate with aging and vascular pathophysiology. We found that among the predicted targets, the expression of multiple extracellular matrix-related genes, including collagen-encoding genes, were downregulated in mice with developmental IGF-1 deficiency. Collectively, IGF-1 deficiency during a critical period during early in life results in persistent changes in post-transcriptional miRNA-mediated control of genes critical targets for vascular health, which likely contribute to the deleterious late-life cardiovascular effects known to occur with developmental IGF-1 deficiency.
Collapse
Affiliation(s)
- Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cory B Giles
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Research Program, Oklahoma City, OK, USA
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Jonathan D Wren
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Research Program, Oklahoma City, OK, USA
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - Nicole M Ashpole
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - M Noa Valcarcel-Ares
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Jeanne Y Wei
- Reynolds Institute on Aging and Department of Geriatrics, University of Arkansas for Medical Science, 4301 West Markham Street, No. 748, Little Rock, AR, 72205, USA
| | - William E Sonntag
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| |
Collapse
|
4
|
|
5
|
Symptomatic unruptured isolated middle cerebral artery dissection: clinical and magnetic resonance imaging features. Clin Neuroradiol 2014; 26:81-91. [DOI: 10.1007/s00062-014-0337-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
|
6
|
Zweifler RM, Silverboard G. Arterial Dissections and Fibromuscular Dysplasia. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Fatal ischemic stroke due to dissecting aneurysm of the intracranial arteries presenting as sudden unexpected death in childhood. Am J Forensic Med Pathol 2010; 31:364-9. [PMID: 21171202 DOI: 10.1097/paf.0b013e3181fbe45a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sudden unexpected death is any nontraumatic death in healthy individuals with normal activities for age until acute demise. Whereas not uncommon in adults and infants, it is considered a rarity in children, with most cases due to infection or occult cardiovascular abnormalities. Pathologic intracranial findings are rarely found in sudden unexpected death in childhood, with most cases due to occult intracranial neoplasms. Cerebral arterial dissection is an uncommon cause of arterial ischemic stroke in childhood. Outcome is poor, with more than 20% of patients dying. We report 4 cases of sudden unexpected death due to arterial ischemic stroke after cerebral arterial dissection in childhood and present a review of the literature.
Collapse
|
8
|
Pezzini A, Del Zotto E, Mazziotti G, Ruggeri G, Franco F, Giossi A, Giustina A, Padovani A. Thyroid Autoimmunity and Spontaneous Cervical Artery Dissection. Stroke 2006; 37:2375-7. [PMID: 16888275 DOI: 10.1161/01.str.0000236500.15976.f3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The possibility that a disorder of immunity might have a role in the mechanism of local inflammatory alterations leading to spontaneous cervical artery dissection (sCAD) has been recently advocated. METHODS We explored this hypothesis in a case-control study, including patients with sCAD (n=29) and patients with non-CAD ischemic stroke (non-CAD; n=29). Serum levels of antithyroperoxidase, antithyroglobulin, and antithyroid-stimulating hormone receptor antibodies, antinuclear antibodies, antineutrophil cytoplasmic antibodies, antidouble-stranded deoxyribonucleic acid antibodies, antiextractable nuclear antigen antibodies, rheumatoid factor, C3 and C4 complement fraction, and cryoglobulins were measured in all subjects. RESULTS Antithyroid autoimmunity was found in 31.0% (9 of 29) of patients with sCAD and 6.9% (2 of 29) of patients with non-CAD ischemic stroke (P=0.041). CONCLUSIONS Autoimmunity may be involved in the process of local inflammation related to sCAD occurrence. The hypothesis that the arterial disease might be one phenotypic expression of a generalized activation of immunity warrants further investigations.
Collapse
Affiliation(s)
- Alessandro Pezzini
- Dipartimento di Scienze Mediche e Chirurgiche, Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
There are a large variety of non-atherosclerotic causes of ischemic stroke in the young. Arterial dissection, most commonly associated with non-traumatic causes, is among the most common. Both the carotid and vertebrobasilar circulations can be affected. The vasculitidies represent a rare, but potentially treatable series of conditions that can lead to stroke through diverse mechanisms. Moyamoya is a nonatherosclerotic, noninflammatory, nonamyloid vasculopathy characterized by chronic progressive stenosis or occlusion of the distal internal carotid arteries and/or proximal portions of the middle and/or anterior cerebral arteries. Moyamoya can be idiopathic (moyamoya disease) or the result of other conditions. An appreciation of the unusual causes of stroke in the young is important when considering secondary prevention measures.
Collapse
Affiliation(s)
- Osvaldo Camilo
- Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Duke University, Durham, NC 27710, USA
| | | |
Collapse
|
10
|
Lin CH, Jeng JS, Yip PK. Middle cerebral artery dissections: Differences between isolated and extended dissections of internal carotid artery. J Neurol Sci 2005; 235:37-44. [PMID: 15946687 DOI: 10.1016/j.jns.2005.03.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Revised: 03/02/2005] [Accepted: 03/23/2005] [Indexed: 11/24/2022]
Abstract
Isolated middle cerebral artery dissection (MCAD) has rarely been encountered clinically and few have reviewed it systemically. The etiologies, clinical manifestations, natural clinical course and prognosis of MCAD remain poorly understood. From 1995 to 2004, there were 5 cases diagnosed clinically and angiographically to have MCAD (isolated MCAD in 1, ICAD-MCAD in 4) from a medical center in Taiwan. MEDLINE (1966-2003) was searched for published articles in English that concerned the diagnosis of MCAD. Clinical presentations, stroke types, angiographic findings, etiologies, treatment strategies and outcomes were compared between cases with isolated MCAD or ICAD-MCAD. There were 23 cases (male, 46%; mean age, 22.9+/-19.5 years) with 24 events of isolated MCAD and 31 cases (male, 47%; mean age, 22.2+/-12.9 years) with 35 events of ICAD-MCAD. The types of stroke in isolated MCAD group included subarachnoid hemorrhage (12%) and cerebral infarction (88%); and in ICAD-MCAD group were subarachnoid hemorrhage (6%) and cerebral infarction (94%). The presenting symptoms were similar between both groups. Fluctuating course was more often in isolated MCAD than in ICAD-MCAD (17% vs. 3%, p=0.061). Recurrence of dissection events in both groups was infrequent (4% vs. 9%, p=0.56). Both groups had high case-fatality rates (MCAD, 48%; ICAD-MCAD, 58%). The cause of dissection in both groups was idiopathic in the majority. Congenital vessel wall defects were found in 26% of ICAD-MCAD, but in only 4% of isolated MCAD (p=0.066). In contrast, preceded trauma was more often found in isolated MCAD than ICAD-MCAD (35% vs. 19%, p=0.085). Arteritis was noted in 16% of ICAD-MCAD patients, but none in isolated MCAD. Angiography revealed segmental stenosis in 72% of isolated MCAD and 96% of ICAD-MCAD. Aneurysmal dilatation of the involved cerebral arteries was noted in 28% of isolated MCAD, but none in MCAD-ICAD. Both isolated MCAD and ICAD-MCAD can cause vascular events with high mortality rates. Several aspects differed between 2 groups, including clinical course, underlying etiologies and angiographic findings.
Collapse
Affiliation(s)
- Chin-Hsien Lin
- Stroke Center and Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 100, Taiwan, ROC
| | | | | |
Collapse
|
11
|
Ogiwara H, Maeda K, Hara T, Kimura T, Abe H. Spontaneous Intracranial Internal Carotid Artery Dissection Treated by Intra-arterial Thrombolysis and Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in the Acute Stage-Case Report-. Neurol Med Chir (Tokyo) 2005; 45:148-51. [PMID: 15782006 DOI: 10.2176/nmc.45.148] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 22-year-old man presented with sudden onset of right retro-orbital headache followed by left hemiparesis. Right carotid angiography demonstrated almost total occlusion of the intracranial internal carotid artery (ICA) and severe stenosis of the middle cerebral artery (MCA), presumably caused by arterial dissection. Local arterial injection of urokinase was performed 2 hours after onset. The ICA became patent, but the M2 portion of the MCA was still occluded, and the left hemiparesis did not improve. Superficial temporal artery-MCA anastomosis was immediately performed. The left hemiparesis disappeared completely 6 days after this procedure. Angiography 2 weeks after the onset revealed occlusion of the ICA, and maintenance of blood flow to the right cerebral hemisphere via the anastomosis. Magnetic resonance imaging showed small infarcts in the right cerebral cortex. Repeat angiography after 5 months showed recanalization of the right ICA and the right MCA. Combination of thrombolytic therapy and bypass surgery may be a useful treatment option for patients with sudden occlusion of the intracranial artery caused by dissection.
Collapse
Affiliation(s)
- Hideki Ogiwara
- Department of Neurosurgery, Aizu Central Hospital, Aizuwakamatsu, Fukushima.
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Anxionnat R, de Melo Neto JF, Bracard S, Lacour JC, Pinelli C, Civit T, Picard L. Treatment of hemorrhagic intracranial dissections. Neurosurgery 2003; 53:289-300; discussion 300-1. [PMID: 12925243 DOI: 10.1227/01.neu.0000073417.01297.93] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2002] [Accepted: 04/09/2003] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the treatment options in hemorrhagic intracranial dissections. METHODS This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.
Collapse
Affiliation(s)
- René Anxionnat
- Department of Neuroradiology, Nancy University Hospital, Nancy, France.
| | | | | | | | | | | | | |
Collapse
|
14
|
Rhodes RH, Phillips S, Booth FA, Magnus KG. Dissecting hematoma of intracranial internal carotid artery in an 8-year-old girl. Can J Neurol Sci 2001; 28:357-64. [PMID: 11766782 DOI: 10.1017/s0317167100001591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND An 8-year-old girl had a minor fall without head trauma and she collapsed the following day while playing. She was awake but mute with focal neurologic signs when admitted to hospital. Radiologic imaging studies showed a progressive left cerebral infarct with left hemisphere vascular narrowing and beading. She died on the third hospital day. METHODS Autopsy including exploration of neck vessels and neuropathological examination was performed. Postmortem studies included immunostaining for immunoglobulins and fixed complement. RESULTS Subtotal subintimal dissections of both proximal supraclinoid internal carotid arteries were found microscopically. On the left, the subintimal dissection extended into the major branches of the left internal carotid artery as dissecting hematomas with a major compromise of the arterial lumina. Specific IgM deposition at the dissection sites was found. A literature review shows that subintimal dissection of the intracranial internal carotid artery or its branches occurs rarely, it is often fatal, and it is present in patients with a mean age of 17.5 years in cases studied pathologically. Trauma and physical exertion are the most common associated factors. CONCLUSIONS Among the causes of ischemic stroke in young individuals, dissecting hematomas of the intracranial portions of the internal carotid artery system rank low. Few reported cases have identifiable pre-existing pathology. The pathogenesis of dissecting hematomas in this region is reviewed and expanded with speculation regarding relevant developmental, anatomical, flow stress and possibly humoral factors that are involved in the disruption of the arterial elastica and subsequent development and extension of a subintimal hematoma resulting in luminal closure and often death.
Collapse
Affiliation(s)
- R H Rhodes
- Department of Pathology, University of Manitoba, Health Sciences Centre, Winnipeg, Canada
| | | | | | | |
Collapse
|
15
|
Silverboard G, Tart R. Cerebrovascular arterial dissection in children and young adults. Semin Pediatr Neurol 2000; 7:289-300. [PMID: 11205718 DOI: 10.1053/spen.2000.2077] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dissection of the cervical and intracranial portions of the carotid and vertebrobasilar arteries may occur spontaneously or in association with trauma or other underlying risk factors. Astute recognition allows appropriate diagnostic and therapeutic protocols to be instituted. Dissection of extracranial carotid and vertebral arteries differ from their intracranial counterparts, both in terms of presentation and prognosis. Limited data are available regarding the most effective medical treatment of dissection in children and young adults. Interventional neuroradiology may offer a new approach in difficult cases. A multicenter controlled clinical trial is needed to assess the most effective treatment.
Collapse
Affiliation(s)
- G Silverboard
- Department of Child Neurology, University of South Alabama College of Medicine, Mobile, USA
| | | |
Collapse
|
16
|
Park-Matsumoto YC, Tazawa T. Transcranial bypass for spontaneous intracranial carotid artery dissection--a case report. Angiology 2000; 51:335-40; discussion 340-1. [PMID: 10779005 DOI: 10.1177/000331970005100410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of spontaneous intracranial artery dissection (IAD) of the anterior circulation is reported. A 32-year-old man developed left hemiparesis with headache. Angiographies (AGs) showed progressive occlusion of the distal end of the right internal carotid artery. He underwent a superficial temporal artery-middle cerebral artery anastomosis 20 days after his initial symptoms. He improved gradually after operation. The prognosis and treatment of IAD are discussed. The authors conclude that cases with IADs of the anterior circulation should be followed up by cerebral AG or magnetic resonance angiography and that early bypass surgery should be considered to prevent massive cerebral infarction in some cases.
Collapse
|
17
|
Lanzino G, Kaptain G, Kallmes DF, Dix JE, Kassell NF. Intracranial dissecting aneurysm causing subarachnoid hemorrhage: the role of computerized tomographic angiography and magnetic resonance angiography. SURGICAL NEUROLOGY 1997; 48:477-81. [PMID: 9352812 DOI: 10.1016/s0090-3019(97)00178-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND With increasing frequency, dissecting aneurysms of the intracranial arteries are recognized as a possible cause of subarachnoid hemorrhage (SAH). In the presence of a dissecting aneurysm, angiographic changes may be subtle at presentation and correct diagnosis often requires serial angiograms. We report a patient with a dissecting aneurysm of the anterior cerebral artery (ACA) causing SAH, in whom less invasive diagnostic tools, such as high-resolution computerized tomographic angiography (CTA) and magnetic resonance angiography (MRA), were helpful in confirming the diagnosis and in following the evolution of the dissection. CASE PRESENTATION We present this 51-year old woman who experienced the sudden onset of severe headache without associated neurological deficits. Head CT showed SAH with blood in the interhemispheric fissure, suggesting a ruptured ACA aneurysm. Serial cerebral angiograms failed to demonstrate an aneurysmal sac, but showed evolving irregularities of the ACA consistent with a dissecting aneurysm. These findings were confirmed by CTA and MRA. The patient was treated conservatively and made an excellent recovery. A MRA obtained 2 months later showed slight improvement of the previously visualized ACA dilatation. CONCLUSION Serial angiograms are often required to confirm the diagnosis and to follow the evolution of an intracranial dissection. With recent advances in neuroradiological techniques, however, critical information can be obtained by less invasive imaging studies, such as CTA and MRA.
Collapse
Affiliation(s)
- G Lanzino
- Department of Neurosurgery, Virginia Neurological Institute, University of Virginia, Charlottesville 22908, USA
| | | | | | | | | |
Collapse
|
18
|
Mizutani T. Middle cerebral artery dissecting aneurysm with persistent patent pseudolumen. Case report. J Neurosurg 1996; 84:267-8. [PMID: 8592231 DOI: 10.3171/jns.1996.84.2.0267] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The extremely rare condition of an ischemic right middle cerebral artery dissecting aneurysm with persistent patent pseudolumen is described. In the majority of cases of dissecting aneurysms, the pseudolumen persists for a very short time, probably because reentry from the pseudolumen is minimal or nonexistent. In contrast, the present case was assumed to have sufficient reentry from the bypass flow in the pseudolumen. Endothelial formation both in the true lumen and the pseudolumen was suggested as the possible mechanism of the stabilized double lumen.
Collapse
Affiliation(s)
- T Mizutani
- Department of Neurosurgery, Showa General Hospital, Tokyo, Japan
| |
Collapse
|
19
|
O'Boynick P, Green KD, Batnitzky S, Kepes JJ, Pietak R. Aneurysm of the left middle cerebral artery caused by myxoid degeneration of the vessel wall. Stroke 1994; 25:2283-6. [PMID: 7974558 DOI: 10.1161/01.str.25.11.2283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Myxoid degeneration of arterial walls may result in dissection and dissecting aneurysms in extracranial and intracranial portions of cerebral arteries. Rarely, saccular aneurysms may also develop on that basis, but thus far these have only been reported in the cervical portions of the carotid arteries. We describe a case of a nondissecting aneurysm of the left middle cerebral artery caused by myxoid degeneration of the media. CASE DESCRIPTION A 39-year-old man had acute onset of frontal headache and neck stiffness. Computed tomographic scan and lumbar puncture established the presence of subarachnoid hemorrhage. Angiography demonstrated a left middle cerebral artery aneurysm. This was clipped and the wall biopsied. Microscopically the entire thickness of the vascular wall showed marked myxoid alterations. No dissection was present. The patient had an uneventful recovery. CONCLUSIONS This observation confirms that myxoid degeneration of arterial walls may cause aneurysms with eventual rupture even in the absence of dissection. Rare cases of this type of aneurysm have been reported to occur in the cervical portions of the carotid arteries, but this is the first reported observation of such changes involving an intracerebral artery.
Collapse
Affiliation(s)
- P O'Boynick
- Department of Surgery (Section of Neurosurgery), University of Kansas College of Health Sciences and Hospital, Kansas City 66160-7410
| | | | | | | | | |
Collapse
|
20
|
Kalapurackal M, Shuaib A, Lowry NJ. Ischemic stroke in children: Relationship to unsuspected trauma. J Stroke Cerebrovasc Dis 1994; 4:57-62. [PMID: 26487537 DOI: 10.1016/s1052-3057(10)80148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Thirteen cases of ischemic stroke in children were seen and followed up between 1981 and 1990. Brain hemorrhage and strokes due to meningitis, leukemia, or other malignancy were excluded. In four, no cause was found. Three were related to trauma that preceded the stroke by up to 24 h. Two were due to cardiac emboli, which occurred during cardiac catheterization for dilation of stenotic valves, and two occurred spontaneously in association with mitral valve prolapse. One stroke was related to an inapparent neurocutaneous syndrome, and one was related to a hyperlipidemia. Follow-up showed no recurrence. School performance and developmental assessment was normal in 11 of 13 (one had a learning disability and the other had hyperactivity). Mild motor deficits persisted in five, were moderate in two, and were severe in one. The overall prognosis was best in children under 5 years.
Collapse
Affiliation(s)
- M Kalapurackal
- From the University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | |
Collapse
|
21
|
Sasaki O, Koike T, Takeuchi S, Tanaka R. Serial angiography in a spontaneous dissecting anterior cerebral artery aneurysm. SURGICAL NEUROLOGY 1991; 36:49-53. [PMID: 2053074 DOI: 10.1016/0090-3019(91)90133-t] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intracranial dissecting aneurysms are uncommon, and little is known concerning the natural history of these lesions. In this paper we present a rare case of dissecting aneurysm of the anterior cerebral artery in which a true diagnostic sign of "double lumen" was demonstrated. Sequential changes in angiographic features shown on serial angiographic studies are described, and diagnosis is briefly discussed.
Collapse
Affiliation(s)
- O Sasaki
- Department of Neurosurgery, Kuwana Hospital, Niigata City, Japan
| | | | | | | |
Collapse
|
22
|
Pozzati E, Padovani R, Fabrizi A, Sabattini L, Gaist G. Benign arterial dissections of the posterior circulation. J Neurosurg 1991; 75:69-72. [PMID: 2045921 DOI: 10.3171/jns.1991.75.1.0069] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Four young adults with spontaneous dissection of the vertebrobasilar system are reported. Clinically, two patients presented with subarachnoid hemorrhage and two with brain-stem ischemia. In two cases of ruptured arterial dissection of the posterior cerebral artery, angiography demonstrated fusiform and "sausage-like" dilatation of the involved vessel. In two cases of occlusive dissection of the basilar artery, angiography revealed the typical "string sign." All four patients were treated conservatively: three survive in good clinical condition and one remains disabled. Follow-up angiograms showed spontaneous healing of the lesion with return to an almost normal arterial configuration in two cases; residual narrowing corresponding to the dissection was the most notable finding in the other two. It is recommended that, in a subset of neurologically stable patients, angiographic monitoring is undertaken to assess the tendency for spontaneous repair before surgical intervention is planned.
Collapse
Affiliation(s)
- E Pozzati
- Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | | | | | | | | |
Collapse
|
23
|
Abstract
We observed significant lesions of the carotid artery siphon in two young subjects with fatal stroke. Because stroke in children and adolescents is uncommon and poorly understood, we examined the internal carotid artery in the 'siphon' of the skull in 24 unselected, but nearly consecutive autopsies. The age range was 10 days to 38 years, with 11 males and 13 females, six blacks, and 18 whites. In no case was stroke the cause of death. Intimal lesions of two types were found in the carotid siphon of all cases. (1) The first was focal splitting and/or duplication of the internal elastic lamina with variable proliferation of smooth muscle. The resulting 'fibrous' plaques or cushions, when severe, were usually found at natural bends in the artery. The number and severity of this type of lesion increased with age, but there were no differences in severity or distribution when compared by sex, race, or mode of death. (2) The second was internal elastic calcification which was found in all cases older than 9. This was increasingly severe with age. Although the frequency of the vascular lesions was surprisingly high, the relationship of either type to dissecting aneurysm or other stroke lesion remains unclear.
Collapse
Affiliation(s)
- M A Bergevin
- Department of Pathology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899
| | | | | | | |
Collapse
|
24
|
Nichols FT, Mawad M, Mohr JP, Stein B, Hilal S, Michelsen WJ. Focal headache during balloon inflation in the internal carotid and middle cerebral arteries. Stroke 1990; 21:555-9. [PMID: 2326836 DOI: 10.1161/01.str.21.4.555] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although a number of reports are available on the occurrence of headache in patients with ischemic cerebrovascular disease, most studies have recorded the frequency but not the specific sites of the pain. We report 18 patients who underwent balloon inflation in the distal internal carotid artery and middle cerebral artery stem during embolization therapy for intracerebral arteriovenous malformations. Eleven patients had reproducible patterns of headache during balloon inflation. Inflation in the proximal middle cerebral artery stem produced pain primarily in the ipsilateral temple, that in the middle of the middle cerebral artery stem produced pain referred primarily retro-orbitally, and inflation in the distal middle cerebral artery stem produced pain referred primarily to the forehead. Experimental studies have demonstrated similar patterns of referred pain. The fact that these areas of referred pain are so reproducible is of potentially great clinical importance in the approach to management of patients with cerebrovascular disease.
Collapse
Affiliation(s)
- F T Nichols
- Department of Neurology, Medical College of Georgia, Augusta 30912
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
A previously healthy 46-year-old woman had the abrupt onset of aphasia and right hemiplegia from a large left-hemisphere infarct. At postmortem examination the cause of the infarct was dissection and occlusion of the intracranial carotid artery. No preexisting abnormality was found to account for the dissection. This uncommon cause of stroke and its pathogenesis are discussed.
Collapse
Affiliation(s)
- M S Pessin
- Department of Neurology, Tufts University School of Medicine, Boston, Massachusetts
| | | | | |
Collapse
|
26
|
Farrell MA, Gilbert JJ, Kaufmann JC. Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psychiatry 1985; 48:111-21. [PMID: 3981168 PMCID: PMC1028209 DOI: 10.1136/jnnp.48.2.111] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The clinical pathological features of fatal arterial dissection confined to the intracranial vessels are described. Three patients with anterior circulation dissections presented with focal ischaemic neurological deficits and pathological examination of involved vessels revealed a dissection plane between internal elastic lamina and media accompanied by intravascular thrombosis. Three of four patients with posterior circulation dissections had clinical pathological features of subarachnoid haemorrhage and at necropsy had transmural dissections. In contrast to previous reports, primary vasculopathies either degenerative or inflammatory were not identified in affected vessels. The pathogenesis of intracranial arterial dissection is discussed and the clinical features are correlated with the pathological abnormalities.
Collapse
|
27
|
Berger MS, Wilson CB. Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 1984; 61:882-94. [PMID: 6491734 DOI: 10.3171/jns.1984.61.5.0882] [Citation(s) in RCA: 217] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Dissecting aneurysms of the intracranial posterior circulation are unusual lesions that affect otherwise healthy young adults, are difficult to diagnose and manage, and carry a high morbidity and mortality rate. Headache in the suboccipital-posterior cervical region is the most common presenting symptom. The dissection usually occurs between the intima or internal elastic lamina and the media; subadventitial dissection does occur and accounts for the infrequent finding of subarachnoid hemorrhage. A deficit in the inner layers of the vessel is the proposed source of dissection. The angiographic features are inconsistent, although an irregularly narrowed arterial segment with proximal and/or distal dilatation are typical findings. Depending on the location of the dissection, the surgical options are: ligation, trapping, or reinforcement of exposed abnormal portions of the vessel. Anticoagulation therapy is not indicated in the management of this lesion.
Collapse
|
28
|
|
29
|
Yamashita M, Tanaka K, Matsuo T, Yokoyama K, Fujii T, Sakamoto H. Cerebral dissecting aneurysms in patients with moyamoya disease. Report of two cases. J Neurosurg 1983; 58:120-5. [PMID: 6847898 DOI: 10.3171/jns.1983.58.1.0120] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dissecting intracranial arterial aneurysms were identified in a 16-year-old girl and a 48-year-old man with moyamoya disease. Hemiplegia or tetraplegia rapidly developed. Angiography revealed bilateral stenoses or occlusion of the bifurcation of the internal carotid arteries (ICA's) and an unusual vascular network at the base of the brain. Autopsy confirmed massive hemorrhage from the thalamus and putamen, with intraventricular extension. The intracranial segments of both ICA's were markedly stenotic in both patients, due to eccentric fibroelastic intimal thickening. In one patient, a dissecting aneurysm was identified microscopically, involving the proximal segment of the left anterior cerebral artery. In the other patient, the right middle cerebral artery (MCA) was dissected beneath the internal elastic lamina along the entire length of the horizontal segment of the MCA. Thus, cerebral dissecting aneurysms may be present in patients with moyamoya disease.
Collapse
|