Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Spontaneous Dissecting Aneurysm of the Anterior Cerebral Artery

  • Kim, Myoung-Soo (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Lee, Chae-Heuck (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Lee, Seung-Joon (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine) ;
  • Rhee, Jong-Joo (Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine)
  • Published : 2006.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Spontaneous dissection of the anterior cerebral artery is an unusual cause of subarachnoid hemorrhage. We present a case of a dissecting aneurysm of the anterior cerebral artery presenting with subarachnoid hemorrhage. A 51-year-old woman presented to our hospital with severe headache. Neurological examination demonstrated neck stiffness, decreased visual acuity of the left eye, and left ankle weakness. Computed tomographic scans showed subarachnoid hemorrhage. The initial cerebral angiogram demonstrated a slightly narrowed caliber and mild poststenotic dilation of the right A1 segment. A second cerebral angiogram 14 days later revealed no change in the focal narrowing of the proximal A1 segment but marked progression of the dilatation of the distal A1 segment. Right pterional craniotomy was performed. A sausage-like dilation of the right A1 segment was found with no definite mural hematoma. This abnormal right A1 segment was wrapped with a Sundt clip. A postoperative computed tomographic scan revealed Infarction of the right head of the caudate nucleus and the anterior limb of the right internal capsule. If a dissecting aneurysm is suspected, serial angiographic studies should be performed because of the possibility of dynamic changes over a short period.

Keywords

References

  1. Ajir F, Tibbetts JC : Post-traumatic occlusion of the supraclinoid internal carotid artery. Neurosurgery 9 : 173-176, 1981 https://doi.org/10.1227/00006123-198108000-00012
  2. Amagasa M, Sato S, Otabe K : Posttraumatic dissecting aneurysm of the anterior cerebral artery : case report. Neurosurgery 23 : 221-225, 1988 https://doi.org/10.1227/00006123-198808000-00016
  3. 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 91 : 682-686, 1999 https://doi.org/10.3171/jns.1999.91.4.0682
  4. Berger MS, Wilson CB : Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61 : 882-894, 1984 https://doi.org/10.3171/jns.1984.61.5.0882
  5. Kitanaka C, Tanaka J, Kuwahara M, Teraoka A : Magnetic resonance imaging study of intracranial vertebrobasilar artery dissections. Stroke 25 : 571-575, 1994 https://doi.org/10.1161/01.STR.25.3.571
  6. Koyama S, Kotani A, Sasaki J : Spontaneous dissecting aneurysm of the anterior cerebral artery : report of two cases. Surg Neurol 46 : 55-61, 1996 https://doi.org/10.1016/0090-3019(95)00485-8
  7. Lee JW, Lee KC : Spontaneous Dissecting Aneurysm of the Anterior Cerebral Artery : Report of 2 Cases. Korean J Cerebrovasc Dis 3 : 73-77, 2001
  8. Matsumoto S, Takada T, Kazui S, Arihiro S, Hasegawa Y, Yamaguchi T, et al : 3D-rotational angiographic demonstration of dissection of the anterior cerebral artery. Cerebrovasc Dis 20 : 55-58, 2005 https://doi.org/10.1159/000086491
  9. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T : Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36 : 905-913, 1995 https://doi.org/10.1227/00006123-199505000-00003
  10. Mizutani T, Kojima H, Asamoto S, Miki Y : Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms. J Neurosurg 94 : 712-717, 2001 https://doi.org/10.3171/jns.2001.94.5.0712
  11. Nakatomi H, Nagata K, Kawamoto S, Shiokawa Y : Ruptured dissecting aneurysm as a cause of subarachnoid hemorrhage of unverified etiology. Stroke 28 : 1278-1282, 1997 https://doi.org/10.1161/01.STR.28.6.1278
  12. Ohkuma H, Suzuki S, Ogane K : Study Group of the Association of Cerebrovascular Disease in Tohoku, Japan : Dissecting aneurysms of intracranial carotid circulation. Stroke 33 : 941-947, 2002 https://doi.org/10.1161/01.STR.0000013564.73522.05
  13. Okuno S, Ochiai C, Nagai M : Dissecting aneurysm of the anterior cerebral artery causing hemorrhagic infarction. Surg Neurol 45 : 25-30, 1996 https://doi.org/10.1016/0090-3019(95)00405-X
  14. 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 20 : 145-148, 1997 https://doi.org/10.1007/BF01138201
  15. Quint DJ, Spickler EM : Magnetic resonance demonstration of vertebral artery dissection. Report of two cases. J Neurosurg 72 : 964-967, 1990 https://doi.org/10.3171/jns.1990.72.6.0964
  16. Rinkel GJ, Gijn J, Wijdicks EF : Subarachnoid hemorrhage without detectable aneurysm. A review of the causes. Stroke 24 : 1403-1409, 1993 https://doi.org/10.1161/01.STR.24.9.1403
  17. Sasaki O, Koike T, Tanaka R, Ogawa H : Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report. J Neurosurg 74 : 504-507, 1991 https://doi.org/10.3171/jns.1991.74.3.0504
  18. Stehbens WE : Medial defects of the cerebral arteries of man. J Pathol Bacteriol 78 : 179-185, 1959 https://doi.org/10.1002/path.1700780119
  19. Yonas H, Agamanolis D, Takaoka Y, White RJ : Dissecting intracranial aneurysms. Surg Neurol 8 : 407-415, 1977