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Wang Y, Geng Y, Shi Z, Shi T, Zhang J. Good recovery of subarachnoid hemorrhage concomitant with ischemia due to anterior cerebral artery dissection by conservative treatment: A case report. Exp Ther Med 2017; 14:155-158. [PMID: 28672907 PMCID: PMC5488541 DOI: 10.3892/etm.2017.4462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/06/2017] [Indexed: 11/06/2022] Open
Abstract
The present report describes the case of a 57-year-old woman presenting with subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) due to anterior cerebral artery (ACA) dissection, which exhibited severe stenosis at the origin with distal dilatation of the A2 segment and occlusion of the A3 segment. In this case, computed tomography (CT) revealed SAH in right superior frontal sulcus and the interhemispheric fissure. Magnetic resonance imaging demonstrated acute infarct in the territory of the right ACA. Brain digital subtraction angiography showed severe stenosis at the origin of the A2 segment with distal dilatation and occlusion at the origin of the A3 segment of the right ACA, suggesting a diagnosis of dissection. Only treatment with atorvastatin, her clinical condition subsequently improved. The stenosis and dilatation of A2 segment were ameliorated as demonstrated by a follow-up CT angiography 5 months after onset. SAH concomitant with ischemia caused by ACA dissection is rare. Conservative treatment may be a safe and effective choice for patients with SAH concomitant with AIS due to ACA dissection.
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Iwasaki M, Hattori I, Sasaki M, Ishimori H, Nemoto A, Hikita C, Sato J, Fukuta S, Morimoto M. Stent-assisted coil embolization for anterior cerebral artery dissection presented with cerebral infarction. Surg Neurol Int 2015; 6:182. [PMID: 26677416 PMCID: PMC4681129 DOI: 10.4103/2152-7806.171240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/27/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Compared to those found in the vertebrobasilar system, intracranial dissection in the anterior circulation is relatively rare, especially in the anterior cerebral artery (ACA). Moreover, only several cases of ACA dissection that underwent endovascular treatment have been reported. Here we present a rare case of gradually developing ACA dissecting aneurysm causing cerebral infarction, successfully treated by stent-assisted coil embolization. CASE DESCRIPTION A 36-year-old man was admitted with sudden right hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed cerebral infarction in the left ACA territory, and MR angiography showed segmental stenosis at the A2 portion of the left ACA. Three-dimensional digital subtraction angiogram showed segmental dilatation and stenosis at the left A2 portion. We diagnosed ACA dissection causing acute cerebral infarction and treated the patient conservatively. Five months after the onset, the dissecting artery at the left A2 portion formed a gradually dilating aneurysm, suggesting increased risk for aneurysmal rupture. We attempted endovascular treatment entailing coil embolization of an aneurysm while preserving the left A2 with stent assistance. The patient remained neurologically stable 6 months after the procedure. CONCLUSIONS Although there are few reported cases of ACA dissection where endovascular treatment was attempted, we consider stent-assisted embolization for gradually developing ACA dissecting aneurysm as an alternative method to prevent bleeding and recurrent infarction.
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Affiliation(s)
- Mitsuhiro Iwasaki
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Itaro Hattori
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Makoto Sasaki
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Hisatsugu Ishimori
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Akihiro Nemoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Chiyoe Hikita
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Junko Sato
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Shinya Fukuta
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
| | - Masafumi Morimoto
- Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Jokohama, Japan
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Im TS, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG. Two cases of subarachnoid hemorrhage from spontaneous anterior cerebral artery dissection : a case of simultaneous hemorrhage and ischemia without aneurysmal formation and another case of hemorrhage with aneurysmal formation. J Cerebrovasc Endovasc Neurosurg 2014; 16:119-24. [PMID: 25045652 PMCID: PMC4102751 DOI: 10.7461/jcen.2014.16.2.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 04/25/2014] [Accepted: 06/04/2014] [Indexed: 02/03/2023] Open
Abstract
Spontaneous anterior cerebral artery (ACA) dissection, although extremely rare, is often associated with severe morbidity and mortality. It could lead to cerebral hemorrhage, ischemic stroke, or, rarely, combination of hemorrhage and ischemia due to hemodynamic changes. Prompt and accurate diagnosis is essential for determining the appropriate management. However, the optimal treatment for ACA dissection remains controversial. Herein, we report on two rare cases of subarachnoid hemorrhage (SAH) caused by ACA dissection; a case presenting with simultaneous SAH and infarction without aneurysmal formation and another case presenting with SAH with fusiform aneurysmal formation. A review of the related literature is provided, and optimal treatments for each type of dissection are suggested.
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Affiliation(s)
- Tae-Seop Im
- 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
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Kawaji H, Amano S, Hiramatsu H, Sakai N, Kamio Y, Namba H. Dissecting Aneurysm at the Proximal Segment of the Anterior Cerebral Artery Associated with Infraoptic Course Anterior Cerebral Artery. NMC Case Rep J 2014; 1:12-15. [PMID: 28663945 PMCID: PMC5364937 DOI: 10.2176/nmccrj.2013-0351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/23/2014] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old man presented a subarachnoid hemorrhage caused by a rupture of a dissecting aneurysm at the proximal segment (A1 segment) of the right anterior cerebral artery (ACA). He also had an anomalous artery named infraoptic course ACA and an agenesis of the contralateral ACA A1 segment. Balloon occlusion test at the bifurcation of the right internal carotid artery demonstrated that the distal segments of the bilateral ACAs were perfused through the infraoptic course ACA. Therefore, we surgically trapped the A1 segment including the aneurysm. The patient got discharged without any neurological deficit. Natural course of ACA dissecting aneurysms is unclear because of rarity of the disease and treatment strategy is still controversial. Most of the dissecting aneurysms in the A1 segment are surgically treated, because they often present with massive hemorrhage and poor prognosis. In the present case, the contralateral A1 segment was absent but trapping of the dissecting aneurysm could be achieved without vascular reconstruction (e.g., bypass surgery) because of the presence of the infraoptic course ACA.
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Affiliation(s)
- Hiroshi Kawaji
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Shinji Amano
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hisaya Hiramatsu
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Naoto Sakai
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yoshinobu Kamio
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
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Nakiri GS, Al-Khawaldeh M, Parente B, Kessler I, Gory B, Riva R, Mounayer C. Treatment of ruptured intra-cranial internal carotid artery dissection using a flow-diverter stent. J Neuroradiol 2012; 39:271-5. [PMID: 22226815 DOI: 10.1016/j.neurad.2011.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/12/2011] [Accepted: 10/20/2011] [Indexed: 11/26/2022]
Abstract
In the presence of associated subarachnoid hemorrhage, the treatment of arterial dissection can be classified as either deconstructive (involving occlusion or sacrifice of the parent vessel) or reconstructive (preserving blood-flow through the parent vessel). In both treatment strategies, the main goal is to prevent any further risk of rebleeding. However, reconstructive treatment is reserved only for those patients in whom occlusion of the parent vessel is not feasible due to an insufficient collateral supply. This report is of a case of intra-cranial carotid artery dissection treated by a reconstructive endovascular approach, with deployment of a flow-diverter stent, for the management of an associated subarachnoid hemorrhage. This is, to the authors' knowledge, the first report of the use of a flow-diverter device as the main treatment of a ruptured supraclinoid carotid artery dissection.
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Affiliation(s)
- Guilherme S Nakiri
- Department of Interventional Neuroradiology, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
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Shimoyama T, Kimura K, Iguchi Y, Shibazaki K, Watanabe M, Sakai K, Sakamoto Y, Aoki J. Spontaneous intra-cranial arterial dissection frequently causes anterior cerebral artery infarction. J Neurol Sci 2011; 304:40-3. [PMID: 21402388 DOI: 10.1016/j.jns.2011.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 02/15/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous intra-cranial arterial dissection (SICAD) without history of head and neck injury is now recognized as an important cause of stroke. However, the frequency of SICAD involving the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) territories remains unclear. This study therefore investigated the distribution of SICAD. METHODS Subjects comprised 194 patients (126 men, 68 women; median age, 68.0 years) with infarct isolated to the ACA, MCA or PCA territories who underwent conventional angiography. Diagnosis of SICAD was based on clinical and neuroradiological findings. Frequency of SICAD was compared among ACA, MCA, and PCA infarcts. All patients were divided into SICAD and non-SICAD groups, and clinical characteristics were compared between groups. RESULTS Infarcts involved the ACA in 14 cases (7.2%), MCA in 165 cases (85.1%), and PCA in 15 cases (7.7%). SICAD was diagnosed in 17 of 194 cases (8.8%), with cerebral angiography showing main findings of the string sign in 11 patients (64.7%), the pearl and string sign in 6 patients (35.3%), and pseudoaneurysm formation in 2 patients (11.7%). SICAD most frequently involved the ACA (ACA, 64.3%; MCA, 4.2%; PCA, 6.7%; P<0.001). CONCLUSION SICAD was seen in 64.3% of patients with ACA infarct. The mechanisms of ACA infarction may thus differ from those of MCA and PCA infarction.
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Affiliation(s)
- Takashi Shimoyama
- Department of Stroke Medicine, Kawasaki Medical School, 557 Matsushima, Kurashiki City Okayama 701-0192, Japan.
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Inoue T, Fujimura M, Matsumoto Y, Kondo R, Inoue T, Shimizu H, Tominaga T. Simultaneous occurrence of subarachnoid hemorrhage and cerebral infarction caused by anterior cerebral artery dissection treated by endovascular trapping. Neurol Med Chir (Tokyo) 2010; 50:574-7. [PMID: 20671384 DOI: 10.2176/nmc.50.574] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old man presented with a rare dissection of the anterior cerebral artery (ACA) causing simultaneous subarachnoid hemorrhage (SAH) and cerebral infarction manifesting as sudden onset of headache and left hemiparesis. Computed tomography and magnetic resonance imaging showed SAH localized in the interhemispheric fissure and cerebral infarction in the territory of the right ACA. Digital subtraction angiography (DSA) demonstrated segmental narrowing and dilatation at the right A(1) and A(2) portions of the ACA, leading to a diagnosis of ACA dissection. Fourteen days after the onset, DSA confirmed the enlarged fusiform dilatation of the right A(2) portion with distal narrowing, suggesting the risk of rerupture of the dissection. Endovascular obliteration of the aneurysm with parent artery occlusion was performed without anastomosis on day 16. The aneurysm was catheterized and obliterated with detachable coils. Postoperative DSA revealed complete obliteration of the dissection and parent artery. The patient was doing well without recurrence of the dissection 8 months after the intervention. The simultaneous occurrence of SAH and cerebral infarction in patients with ACA dissection is extremely rare, and the optimal treatment has not yet been established. Endovascular treatment is safe and effective for the treatment of ACA dissection.
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Affiliation(s)
- Tomoo Inoue
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
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8
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Uozumi Y, Katoh H, Tsuzuki N, Toyooka T, Miyazawa T, Nawashiro H, Shima K. Revascularization for anterior cerebral artery dissecting aneurysms--three case reports. Neurol Med Chir (Tokyo) 2010; 50:49-53. [PMID: 20098026 DOI: 10.2176/nmc.50.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe three rare cases of dissecting aneurysms in the anterior cerebral artery (ACA) treated by surgical reconstruction, and reviewed 79 previously reported cases with the ACA dissecting aneurysm. We found that 35 (77.8%) of 45 patients with ischemic event and 15 (40.5%) of 37 patients with hemorrhagic event were treated conservatively, with 11.4% (4/35 cases) and 13.3% (2/15) risk of bleeding and rebleeding, respectively. Furthermore, half of these patients died. The other 32 patients were treated surgically, and their outcome was favorable, especially after surgical reconstruction. Simultaneous treatment of both hemorrhagic and ischemic events is essential. We recommend early treatment with revascularization for patients with ACA dissection that has hemorrhaged and for patients presenting with signs of clinical deterioration with ischemic event.
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Affiliation(s)
- Yoichi Uozumi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
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9
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Chang SK, Kim KH, Yoon DY, Kim EJ. Endovascular Treatment for Isolated Dissecting Aneurysm of The Pericallosal Artery Presenting with Spontaneous Subarachnoid Hemorrhage: A Case Report. Neurointervention 2010. [DOI: 10.5469/neuroint.2010.5.2.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Suk Ki Chang
- Department of Radiology, Gangdong Sacred Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Keon-Ha Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Dae Young Yoon
- Department of Radiology, Gangdong Sacred Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyunghee University Hospital, School of Medicine, Kyunghee University, Seoul, Korea
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Chronic recanalization of dissection of the distal anterior cerebral artery: case report and review of the literature. Case Rep Med 2009; 2009:303695. [PMID: 19724653 PMCID: PMC2734918 DOI: 10.1155/2009/303695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 07/16/2009] [Indexed: 11/27/2022] Open
Abstract
The natural history of atraumatic idiopathic dissection of the distal anterior cerebral artery is still unclear. We present a 38-year-old man who had dissection of the left A2 segment of this vessel associated with subintimal hematoma and infarction. Because of complete stroke in acute stage, he did not undergo surgery. About three months later, administration of aspirin (100 mg/day) was started. At nine months, magnetic resonance angiography revealed complete recanalization of the A2 dissection. To assess the outcome of dissection, we should observe the patient for at least one year.
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11
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Kodera T, Hirose S, Takeuchi H, Tsuji T, Kubota T. Radiological findings for arterial dissection of the anterior cerebral artery. J Clin Neurosci 2007; 14:77-80. [PMID: 17138072 DOI: 10.1016/j.jocn.2005.12.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 12/02/2005] [Indexed: 11/19/2022]
Abstract
We treated a patient with anterior cerebral artery (ACA) dissection that caused an ischaemic stroke, and investigated serial changes over time by using three different radiological methods. The conventional angiography findings for ACA dissection corresponded to those of computed tomography (CT) angiography, but not those of magnetic resonance angiography for each phase. We presume that the results were based on the velocity of the blood flow in the pseudolumen of the dissected artery, and we believe that CT angiography is a useful and less invasive diagnostic tool for intracranial arterial dissection.
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Affiliation(s)
- Toshiaki Kodera
- Department of Neurosurgery, Fukui General Hospital, Fukui 910-8561, Japan.
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12
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Iwashita T, Kitazawa K, Koyama JI, Nagashima H, Koyama T, Tanaka Y, Hongo K. A saccular-like dissecting aneurysm of the anterior cerebral artery that developed 2 years after an ischemic event. ACTA ACUST UNITED AC 2005; 64:538-41, discussion 541. [PMID: 16293477 DOI: 10.1016/j.surneu.2005.01.023] [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] [Received: 08/03/2004] [Accepted: 01/10/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND A rare case of a growing dissecting aneurysm, which was located at the horizontal (A1) segment of the anterior cerebral artery (ACA), is reported. CASE DESCRIPTION A 53-year-old woman experienced left hemiparesis and alien hand syndrome. A computerized tomography scan showed an infarction in the right frontal lobe, and cerebral angiography revealed a false lumen and intimal flap at the A1 segment of the ACA. Magnetic resonance angiography demonstrated that the stenosis progressed 6 months later and improved 1 year later. Cerebral angiography showed a saccular-like aneurysm 2 years later. The surgery was planned for prevention of aneurysmal rupture. The aneurysm, which was cocoon shaped, was exposed surgically and was resected. Histological examination of the aneurysm showed arterial dissection. The postoperative course was uneventful without additional neurological deficits. CONCLUSION This is the first case report of A1 dissecting aneurysm presenting with an ischemic event in the literature. The sequential change of the configuration was curious to develop aneurysmal dilatation in 2 years. Long-term follow-up is necessary even after disappearance of the arterial dissection.
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Affiliation(s)
- Tomomi Iwashita
- Department of Emergency and Intensive Care Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
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Moro N, Katayama Y, Oshima H, Kano T. Sagittal Magnetic Resonance Imaging of Intramural Hematoma From Non-traumatic Dissection of the Anterior Cerebral Artery-Case Report-. Neurol Med Chir (Tokyo) 2005; 45:300-5. [PMID: 15973063 DOI: 10.2176/nmc.45.300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 46-year-old woman presented with non-traumatic anterior cerebral artery dissection manifesting as sudden onset of headache and motor weakness of the right lower limb. Angiography revealed luminal narrowing of the left anterior cerebral artery from the A(3) portion to the distal portion. Sagittal T(1)-weighted magnetic resonance imaging showed hyperintensity due to an intramural hematoma around the flow void signal of the affected anterior cerebral artery. Sagittal magnetic resonance imaging should be performed in suspected cases of anterior cerebral artery dissection to detect the diagnostic finding of intramural hematoma.
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Affiliation(s)
- Nobuhiro Moro
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
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14
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Abstract
Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial.
To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.
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Day AL, Gaposchkin CG, Yu CJ, Rivet DJ, Dacey RG. Spontaneous fusiform middle cerebral artery aneurysms: characteristics and a proposed mechanism of formation. J Neurosurg 2003; 99:228-40. [PMID: 12924694 DOI: 10.3171/jns.2003.99.2.0228] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to identify the origins of spontaneous fusiform middle cerebral artery (MCA) aneurysms. METHODS One hundred two cases of spontaneous fusiform MCA aneurysms were reviewed, including 40 from the authors' institutions and 62 identified from the literature. The mean age at symptom onset was 38 years, and the male/female ratio was 1.4:1. At presentation, the MCA lumen was stenosed or occluded in 12 patients, focally dilated in 57, and appeared "serpentine" in 33. Most lesions originated from the M1 or M2 segments, and most (80%) presented with nonhemorrhagic symptoms or were discovered incidentally. The presenting clinical features correlated with morphological findings in the aneurysms, which could be observed to progress from a small focal dilation or vessel narrowing to a serpentine channel. Hemorrhage was the most common presentation in small lesions; the incidence of bleeding progressively diminished with larger lesions. Patients with stenoses or occluded vessels most often presented with ischemic symptoms, and occasionally with hemorrhage. Giant focal dilations or serpentine aneurysms were rarely associated with acute bleeding; clinical presentation was most often prompted by mass effect or thromboembolic stroke. CONCLUSIONS Analysis of results after various treatments indicates that for symptomatic lesions, therapies that reverse intraaneurysmal blood flow and augment distal cerebral perfusion are associated with better outcomes than other strategies, including conservative management. Based on the spectrum of clinical, pathological, neuroimaging, and intraoperative findings, dissection is proposed as the underlying cause of these lesions.
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Affiliation(s)
- Arthur L Day
- Department of Neurological Surgery, Brigham and Women's Hospital, Harvard University School of Medicine, Boston, Massachusetts 02115, USA.
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Abstract
BACKGROUND Thunderclap headache (or sudden severe headache) is an uncommon type of headache. Recognition and accurate diagnosis of this headache are important, because there is often a serious underlying brain disorder. SUMMARY In this article, causes and management of thunderclap headache are discussed. In the primary care setting, there is a serious cause in one third of patients, but in the hospital setting, up to two thirds of patients have a serious underlying brain disorder. Clues in history and physical examination can point to a possible serious underlying cause of thunderclap headache, such as subarachnoid hemorrhage, intracranial hematoma, or cerebral venous thrombosis. The remaining patients with thunderclap headache, however, have a primary headache disorder, such as migraine or (less frequently) tension headache with an unusual sudden onset, exertional headache, coital headache, cough headache, or cluster headache. The concept of thunderclap headache as a distinct clinical entity is discussed, with implications for its evaluation. Present radiological techniques are reviewed with regard to their diagnostic utility in detecting a serious brain disorder. CONCLUSIONS Thunderclap headache is an uncommon type of headache, and a serious underlying cause should be excluded.
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Affiliation(s)
- F H H Linn
- Department of Neurology, Central Military Hospital/University Medical Center, Utrecht, the Netherlands.
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17
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Kurino M, Yoshioka S, Ushio Y. Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction: a case report and review of the literature. SURGICAL NEUROLOGY 2002; 57:428-36; discussion 436-8. [PMID: 12176212 DOI: 10.1016/s0090-3019(02)00725-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracranial dissecting aneurysms have been reported with increasing frequency and are recognized as a common cause of stroke. In some reviews and case reports, attempts have been made to compare the outcomes of surgical and medical treatments. However, the appropriate management of dissecting aneurysms in the anterior circulation remains controversial, especially in patients who also manifest cerebral infarction. CASE DESCRIPTION A 45-year-old male was diagnosed as having a dissecting aneurysm of the right middle cerebral artery (MCA) with cerebral infarction. In the course of conservative treatment, he developed a new cerebral infarction in the territory of the right anterior cerebral artery (ACA). Repeat cerebral angiograms revealed an increase in the aneurysmal dilatation of the right M2 and the appearance of a segmental dilatation of the right A2. He continued to be treated conservatively and his course was satisfactory. On subsequent angiograms, we observed resolution of the right A2 dissection and no further progression of the dilatation of the right M2. CONCLUSION This is the first reported case of simultaneous idiopathic dissecting aneurysms of different major arterial branches in the anterior circulation. Our review of the literature disclosed 36 and 23 cases, respectively, of dissecting aneurysms of the ACA and MCA. Many previously reported patients with these dissecting aneurysms involving subarachnoid hemorrhage (SAH) underwent surgery, which resulted in better outcome. More than half of the patients with ACA and MCA dissecting aneurysms had cerebral infarction. All ACA dissecting aneurysms involving ischemia occurred in the A2 region. The outcomes of both surgical and conservative management were equally satisfactory. On the other hand, in patients with MCA dissecting aneurysms, the area of ischemia frequently involved the M1 region; in these patients, conservative treatment resulted in poor outcomes. Therefore, revascularization distal to the compromised artery should be considered in patients with MCA-dissecting aneurysms who have ischemia. Careful interpretation of serial angiograms and/or magnetic resonance (MR) images is necessary because of the possibility of disease progression. If the aneurysmal size increases or there is progression of ischemic symptoms in the course of conservative treatment, surgery must be urgently evaluated.
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Affiliation(s)
- Masahito Kurino
- Department of Neurosurgery, Oita Prefectural Hospital, Bunyo, Oita, Japan
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Sakamoto S, Inagawa T, Ikawa F, Kawamoto H, Ohbayashi N. Anterior cerebral artery dissections manifesting as cerebral hemorrhage and infarction, and presenting as dynamic angiographical changes--case report. Neurol Med Chir (Tokyo) 2002; 42:250-4. [PMID: 12116530 DOI: 10.2176/nmc.42.250] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 65-year-old woman presented with multiple dissecting aneurysms of the anterior cerebral artery (ACA) manifesting as hemiparesis on the right with dominance in the lower extremity. Computed tomography revealed hematoma in the left frontal lobe, corresponding to the area perfused by the callosomarginal artery. Initial angiography showed string sign and occlusion in the distal portion of the left callosomarginal artery and abnormal feeding suggesting double lumen of the A2 portion of the left ACA. The patient was treated conservatively under a diagnosis of multiple spontaneous dissecting aneurysms of the left ACA. Repeat angiography on Day 8 showed improvement of the string sign and occlusion in the left callosomarginal artery, and change of the double lumen of the A2 portion into string sign. Further angiography on Day 36 showed normalization of the left callosomarginal artery and improvement of the string sign in the A2 portion. Multiple spontaneous dissecting aneurysms of the ACA are extremely rare. Serial angiography beginning in the early stage will be important for correct diagnosis.
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Affiliation(s)
- Shigeyuki Sakamoto
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan.
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19
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Uber-Zak LD, Venkatesh YS. Neurologic complications of sit-ups associated with the Valsalva maneuver: 2 case reports. Arch Phys Med Rehabil 2002; 83:278-82. [PMID: 11833035 DOI: 10.1053/apmr.2002.27378] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We present 2 cases of potentially catastrophic neurologic consequences occurring in healthy individuals engaged in sit-up exercises. Two young healthy men were engaged in sit-ups when one developed a stroke and the other developed a spinal epidural hematoma. The Valsalva maneuver involved in the sit-up exercise can produce supraphysiologic increases in blood pressure, which can lead to vascular injury and serious neurologic consequences. Proper breathing should be encouraged and patients with known predisposing factors should avoid such exercises. Prompt recognition of neurologic signs and symptoms during exercise can be life saving. This is the first report of the neurologic complications of sit-ups.
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Affiliation(s)
- Lori D Uber-Zak
- Dept of Neurology, Loma Linda University, Loma Linda, CA 92354, USA
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20
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Gómez PA, Campollo J, Lobato RD, Lagares A, Alén JF. [Subarachnoid hemorrhage secondary to dissecting aneurysms of the vertebral artery. Description of 2 cases and review of the literature]. Neurocirugia (Astur) 2001; 12:499-508. [PMID: 11787398 DOI: 10.1016/s1130-1473(01)70665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED OBJECTIVES AND INTRODUCTION: The pathogenesis and natural history of intracranial vertebral artery dissection remain uncertain up to now due in part to its relative rarity. In this article we review the state of the art of this process and remark the good outcome obtained with embolization using Guglielmi detachable coiling (GDC). METHODS Two cases with subarachnoid hemorrhage secondary to rupture of a vertebral dissection aneurysms are described. The first patient initially suffered brain stem infarction, followed by a subarachnoid hemorrhage a year later. The second patient who had a severe subarachnoid hemorrhage with two early rebleedings was successfully treated with embolization using GDC. CONCLUSIONS Subarachnoid hemorrhage due to rupture of vertebral dissecting aneurysm is a relatively unknown disease with some important aspects that should be known. The high incidence of early rebleeding (up to 60%), makes early diagnosis and treatment important goals. Classically the preferred treatment has been proximal vertebral artery occlusion. However, the recent introduction of embolization with GDC has made possible the occlusion of the dissection with very good final outcome.
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Affiliation(s)
- P A Gómez
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid
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21
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Vinters HV. Cerebrovascular disease--practical issues in surgical and autopsy pathology. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 2001; 95:51-99. [PMID: 11545057 DOI: 10.1007/978-3-642-59554-7_2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- H V Vinters
- Department of Pathology and Laboratory Medicine, Section of Neuropathology, Brain Research Institute and Neuropsychiatric Institute, UCLA Medical Center, CHS 18-170, Los Angeles, California 90095-1732, USA
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22
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Hirao J, Okamoto H, Watanabe T, Asano S, Teraoka A. Dissecting aneurysms at the A1 segment of the anterior cerebral artery--two case reports. Neurol Med Chir (Tokyo) 2001; 41:271-8. [PMID: 11396308 DOI: 10.2176/nmc.41.271] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two rare cases of dissections which involve the anterior cerebral artery (ACA) are reported. A 58-year-old woman presented with a ruptured dissecting aneurysm manifesting as sudden onset of severe headache and consciousness disturbance followed by aphasia, right hemiparesis, paresis of the left lower extremity, and choreoathetotic movements of the upper arms and face. Computed tomography and angiography revealed subarachnoid hemorrhage due to a dissecting aneurysm at the left A1 segment. The dissecting aneurysm was trapped surgically on the day of onset. Her neurological deficits disappeared within a month. A 39-year-old woman experienced continuous dull headache from the day before onset, and then suffered right hemiparesis. Magnetic resonance (MR) imaging revealed cerebral infarction at the left globus pallidus. Angiography and MR imaging revealed a dissecting aneurysm at the left A1 segment and occlusion of the left Heubner's artery. She received conservative treatment and her neurological findings were improved. Dissections or dissecting aneurysms involving the ACA can be classified into three types: Extension of a dissection to the ACA from the internal carotid artery, dissection at the A1 segment, and dissection at the A2-A4 segments. These types of dissection have distinct uniform clinical features.
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Affiliation(s)
- J Hirao
- Department of Neurosurgery, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago, Tottori
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23
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Abstract
The incidence of subarachnoid haemorrhage (SAH) is stable, at around six cases per 100 000 patient years. Any apparent decrease is attributable to a higher rate of CT scanning, by which other haemorrhagic conditions are excluded. Most patients are <60 years of age. Risk factors are the same as for stroke in general; genetic factors operate in only a minority. Case fatality is approximately 50% overall (including pre-hospital deaths) and one-third of survivors remain dependent. Sudden, explosive headache is a cardinal but non-specific feature in the diagnosis of SAH: in general practice, the cause is innocuous in nine out of 10 patients in whom this is the only symptom. CT scanning is mandatory in all, to be followed by (delayed) lumbar puncture if CT is negative. The cause of SAH is a ruptured aneurysm in 85% of cases, non-aneurysmal perimesencephalic haemorrhage (with excellent prognosis) in 10%, and a variety of rare conditions in 5%. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. A poor clinical condition on admission may be caused by a remediable complication of the initial bleed or a recurrent haemorrhage in the form of intracranial haematoma, acute hydrocephalus or global brain ischaemia. Occlusion of the aneurysm effectively prevents rebleeding, but there is a dearth of controlled trials assessing the relative benefits of early operation (within 3 days) versus late operation (day 10-12), or that of endovascular treatment versus any operation. Antifibrinolytic drugs reduce the risk of rebleeding, but do not improve overall outcome. Measures of proven value in decreasing the risk of delayed cerebral ischaemia are a liberal supply of fluids, avoidance of antihypertensive drugs and administration of nimodipine. Once ischaemia has occurred, treatment regimens such as a combination of induced hypertension and hypervolaemia, or transluminal angioplasty, are plausible, but of unproven benefit.
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Affiliation(s)
- J van Gijn
- Department of Neurology, University Medical Centre, Utrecht, The Netherlands.
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24
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Wakabayashi Y, Nakano T, Isono M, Shimomura T, Hori S. Dissecting aneurysm of the anterior cerebral artery requiring surgical treatment--case report. Neurol Med Chir (Tokyo) 2000; 40:624-7. [PMID: 11153192 DOI: 10.2176/nmc.40.624] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 45-year-old male presented with spontaneous dissecting aneurysm in the anterior cerebral artery manifesting as headache persisting for several days and speech disturbance. Neurological and laboratory examinations showed no abnormalities. Magnetic resonance imaging revealed infarction in the right cingulate gyrus. Angiography revealed occlusion of the right A2. Repeat angiography 8 months later showed a saccular aneurysm had developed. The interhemispheric approach exposed the aneurysm at the junction between the right frontopolar artery and the pericallosal artery. The aneurysm was fusiform due to the right A2 dissection. The aneurysm was trapped and resected. One month after the operation, the patient was discharged without neurological deficits. Cases of dissecting aneurysms in the anterior cerebral artery with ischemic onset are usually treated conservatively. Cases requiring surgery include those due to trauma, growing aneurysms, giant aneurysms, and uncontrolled hypertension. Some dissecting aneurysms of the distal anterior cerebral artery require only resection without bypass surgery.
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Affiliation(s)
- Y Wakabayashi
- Department of Neurosurgery, Oita Medical University, Oita
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25
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Kato N, Yamada Y, Hyodo A, Nose T. A Case of Anterior Cerebral Artery Dissection presenting Subarachnoid Hemorrhage and Cerebral Infarction. ACTA ACUST UNITED AC 2000. [DOI: 10.7887/jcns.9.157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Yuzo Yamada
- Department of Neurosurgery, Satte General Hospital
| | - Akio Hyodo
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba
| | - Tadao Nose
- Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba
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26
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Amagasaki K, Yagishita T, Yagi S, Kuroda K, Nishigaya K, Nukui H. Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries. Case report. J Neurosurg 1999; 91:682-6. [PMID: 10507393 DOI: 10.3171/jns.1999.91.4.0682] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 47-year-old man was admitted to the hospital with disturbance of consciousness due to subarachnoid hemorrhage caused by a ruptured dissecting aneurysm of the left anterior cerebral artery (ACA). Conservative treatment resulted in improvement in the patient's consciousness; however, repeated rupture occurred during the chronic stage. Endovascular coil embolization of the parent artery was successful. Serial angiography demonstrated all stages in the development of the aneurysm. Follow-up angiography demonstrated an incidental dissecting aneurysm of the right vertebral artery. This aneurysm was also treated by endovascular embolization. No new neurological deficit appeared during or after the treatment. Multiple dissecting aneurysms are rare, especially those involving both supra- and infratentorial regions. A ruptured dissecting aneurysm of the ACA is also an uncommon vascular disorder. This case shows that rebleeding may occur, even during the chronic stage, and thus appropriate treatment for the prevention of subsequent bleeding is essential. Incidental dissecting aneurysms can be treated using the endovascular technique, but further study is necessary.
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Affiliation(s)
- K Amagasaki
- Department of Neurosurgery, Yamanashi Medical University, Nakakoma-gun, Japan
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27
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Abstract
On the basis of our experience and the available literature, we submit that aggressive screening for BCI based on injury patterns is warranted. However, several important clinical issues remain unresolved. The precise injury patterns and relative cerebrovascular risks remain to be defined. Furthermore, the optimal diagnostic screening test remains to be identified, with consideration of the relative risk-benefit profile. Finally, we must determine the best methods for the treatment of BCI. Although the definitive study has yet to be completed, the use of heparin was associated with a trend toward improved outcomes in symptomatic patients. In addition, no asymptomatic patient experienced the development of new neurologic deficits during heparin therapy. Therefore we believe that the early institution of heparin therapy is indicated. The role of endovascular stenting, however, remains unclear.
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Affiliation(s)
- W L Biffl
- Denver Health Medical Center, University of Colorado Health Sciences Center, USA
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28
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Tuna M, Göçer AI, Ozel S, Bağdatoğlu H, Zorludemir S, Haciyakupoğlu S. A giant dissecting aneurysm mimicking serpentine aneurysm angiographically. Case report and review of the literature. Neurosurg Rev 1999; 21:284-9. [PMID: 10068192 DOI: 10.1007/bf01105787] [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: 10/25/2022]
Abstract
Intracranial dissecting and giant serpentine aneurysms are rare vascular anomalies. Their precise cause has not yet been completely clarified, and the radiological appearance of such lesions can be different in each case according to the effect of hemodynamic stress on a pathologic vessel wall. For berry aneurysms, available evidence overwhelmingly favors their causation by hemodynamically induced degenerative vascular disease and there is an obvious need to determine the hemodynamic parameters most likely to induce the precursor atrophic lesions. In this study, a case of a giant dissecting aneurysm angiographically mimicking serpentine aneurysm of the right ophthalmic artery is reported and the relevant literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. In the present case, radiological investigation of the lesion suggested a serpentine aneurysm, but the diagnosis was corrected to dissecting aneurysm subsequent to the pathological examination of the resected aneurysm. A giant dissecting aneurysm angiographically mimicking serpentine aneurysm and developing as the result of a circumferential dissection located between the internal elastic lamina and media is of particular interest when the etiology of these aneurysms is considered. To our knowledge this is the first report on intracranial dissecting aneurysm mimicking serpentine aneurysm angiographically. Our case illustrates the importance of careful serial section studies for a better understanding of the vascular pathology underlying the processes involved in intracranial serpentine aneurysms. We conclude that serpentine, dissecting and berry aneurysms may all arise by way of similar pathophysiological mechanisms.
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Affiliation(s)
- M Tuna
- Department of Neurosurgery, Cukurova University School of Medicine, Adana, Turkey
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29
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van Gijn J. Pitfalls in the Diagnosis of Sudden Headache. J R Coll Physicians Edinb 1999. [DOI: 10.1177/147827159902900107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Kanai H, Koide K, Niwa Y, Umezu M. Spontaneous Dissection of the A2 Segment of the Anterior Cerebral Artery presenting Cerebral Infarction : A Case Report. ACTA ACUST UNITED AC 1999. [DOI: 10.7887/jcns.8.732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hideki Kanai
- Department of Neurosurgery, Kakegawa City General Hospital
| | - Kazuo Koide
- Department of Neurosurgery, Kakegawa City General Hospital
| | - Yuji Niwa
- Department of Neurosurgery, Kakegawa City General Hospital
| | - Masanari Umezu
- Department of Neurosurgery, Kakegawa City General Hospital
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Skljarevski V, Turek M, Hakim AM. Cervical artery dissection is associated with widened aortic root diameter. Neurol Sci 1998; 25:315-9. [PMID: 9827234 DOI: 10.1017/s031716710003434x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dissection of the internal carotid and vertebral arteries is a well recognized cause of stroke, especially in the middle-aged. The exact etiology of this condition is controversial. According to one theory there is an underlying vasculopathy originating from disturbed development of the neural crest. The neural crest gives rise to several tissues, including the tunica media of large cervical arteries and the outflow tract of the heart. We attempted to test the theory that developmental abnormality at the level of the neural crest may play a role in dissection of the large cervical arteries. METHODS We designed a retrospective case control study. By means of transthoracic echocardiography we measured the aortic root diameter in a group of patients with radiographically determined dissection of at least one large artery in the neck. The results were compared to a control group. RESULTS In comparison to age matched controls, male patients were found to have a significantly larger aortic root. Although a similar trend was apparent in females, the difference between the patient and control group of females was not statistically significant. CONCLUSIONS Patients with cervical artery dissections may have other abnormalities in other organs arising from the neural crest. A larger prospective clinical study and further research are needed to establish a firm link between dissection of the cervical arteries and abnormalities in other organs.
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Affiliation(s)
- V Skljarevski
- Division of Neurology, Ottawa Hospital-General Site, University of Ottawa, Ontario, Canada
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32
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Yamamoto H, Fukuda O, Saito T, Endo S, Takaku A. A Subarachnoid Hemorrhage secondary to a Dissecting Aneurysm of the Anterior Cerebral Artery : A Case Report. ACTA ACUST UNITED AC 1998. [DOI: 10.7887/jcns.7.310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hiromichi Yamamoto
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University Faculty of Medicine
| | | | | | - Shunro Endo
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University Faculty of Medicine
| | - Akira Takaku
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University Faculty of Medicine
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33
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Yamaguchi S, Oki S, Mikami T, Kawamoto Y, Ito Y, Kuwamoto K. A Case of an Intracranial Dissecting Aneurysm localized in the Anterior Cerebral Artery. ACTA ACUST UNITED AC 1998. [DOI: 10.7887/jcns.7.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Shuichi Oki
- Department of Neurosurgery, Hiroshima City Asa Hospital
| | | | | | - Yoko Ito
- Department of Neurosurgery, Hiroshima City Asa Hospital
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34
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Ruptured dissecting aneurysms of both anterior cerebral arteries. J Clin Neurosci 1998; 5:108-10. [DOI: 10.1016/s0967-5868(98)90218-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/1995] [Accepted: 10/12/1995] [Indexed: 11/23/2022]
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35
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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.
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Affiliation(s)
- G Lanzino
- Department of Neurosurgery, Virginia Neurological Institute, University of Virginia, Charlottesville 22908, USA
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36
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Honda N, Yuge T, Miyagi J, Shigemori M. A Surgical Case of Dissecting Aneurysm of the Anterior Cerebral Artery. ACTA ACUST UNITED AC 1997. [DOI: 10.7887/jcns.6.634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Naomi Honda
- Department of Neurosurgery, Saiseikai Futsukaichi Hospital
| | | | - Jun Miyagi
- Department of Neurosurgery, Kurume University Hospital
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37
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Otawara Y, Suzuki M, Abe M, Tomizuka N, Ogawa A. Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report. Neurosurg Rev 1997; 20:145-8. [PMID: 9226677 DOI: 10.1007/bf01138201] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 66-year-old woman presented with dissecting aneurysms of the anterior cerebral artery (ACA) and accessory middle cerebral artery (MCA) manifesting as subarachnoid hemorrhage but without radiological evidence of the dissecting aneurysms. Intraoperative observation revealed that the vessel walls were dark purple in color, a typical finding of dissecting aneurysm. The abnormal A1 segment was trapped and the dissecting aneurysm of the accessory MCA was wrapped. In the case of SAH of unknown origin, dissecting aneurysm should always be kept in mind even if the angiogram does not show any abnormal finding. This is the first reported case of dissecting aneurysm of the accessory MCA.
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Affiliation(s)
- Y Otawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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38
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39
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Rutherfoord GS, Dada MA, Nel JP. Cerebral infarction and intracranial arterial dissection in closed head injury. Am J Forensic Med Pathol 1996; 17:53-7. [PMID: 8838471 DOI: 10.1097/00000433-199603000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This report describes the autopsy findings in three cases of closed head injury dying of cerebral infarction, with brain swelling and herniation. In each instance the cause of the infarct was found to be subintimal dissection involving intracranial anterior circulation arteries. The autopsy findings underscore the value of histological examination of vessels that macroscopically appear thrombosed. We discuss factors that impact on the reported incidence and make brief mention of problems surrounding the true pathogenesis of this lesion.
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Affiliation(s)
- G S Rutherfoord
- Neuropathology Unit, University of Stellenbosch, Cape Town, South Africa
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