Clinical picture of intracranial non‐traumatic dissecting aneurysm

Abstract

Non‐traumatic intracranial arterial dissection has been accepted as a unique entity of ‘cerebral infarction in otherwise healthy young adults’, and is particularly prevalent in Western countries. A recent data collection and analysis have revealed additional clinical features. The nationwide study in Japan conducted in 1996 has provided new information on the natural history and current treatment of intracranial dissecting aneurysms in Japan. The incidence of symptomatic dissection was found to be much higher in the vertebrobasilar system than in the carotid system. The mean age of the patients was 51.3 years. Patients with carotid lesions were younger (mean 43.8 years). The male/female ratio was 2 : 1. Fifty‐eight percent of patients presented with subarachnoid hemorrhage. Recurrence was more frequent in patients with subarachnoid hemorrhage (14%) than in patients with no hemorrhage (4.2%). Common radiological findings were dilatation, ‘pearl and string’ sign and narrowing of the affected artery. Surgical treatment involved a variety of procedures including proximal occlusion, entrapment, wrapping and endovascular embolization. Patients with subarachnoid hemorrhage (61%) underwent surgical treatment more frequently than patients with no hemorrhage (17%). Good recovery was achieved in 64% of all patients. Outcome was better in patients with no subarachnoid hemorrhage compared with those with hemorrhage.

Two Cases of Intracranial Internal Carotid Artery Dissection Presenting with Ischemic Stroke

“…Mizutani et al 7) reported four cases of internal carotid artery dissection presenting with ischemia among 206 cases of intracranial artery dissection. Yamaura et al 1) reported 10 cases of internal carotid artery dissection among 322 non-traumatic intracranial artery dissections and 6 of them were non-hemorrhagic. Since the disorder is frequently presented with neurological symptoms accompanied by headache in relatively young individuals, it is necessary to carefully evaluate the possibility of intracranial artery dissection in young patients presenting with cerebral infarction accompanied by headache.…”

“…Since the disorder is frequently presented with neurological symptoms accompanied by headache in relatively young individuals, it is necessary to carefully evaluate the possibility of intracranial artery dissection in young patients presenting with cerebral infarction accompanied by headache. 1,2,7) There are several characteristics in the images of intracranial internal carotid artery dissection. Although the disorder is often difficult to detect as a clear abnormality on plain CT, a thrombus formed in the vascular wall of the dissected site may be confirmed on MRI, and thrombi are often seen as high-intensity areas particularly on T1-weighted MR imaging.…”

“…1,10,11) On DSA, arterial dissection is more often detected as narrowing or occlusion of the affected artery than as the double lumen sign or pearl and string sign, which are considered to be characteristic findings of arterial dissection, but again its differentiation from atherosclerotic change is difficult similar to MRA. 1,6,[8][9][10] Thus, while it is difficult to definitively diagnose intracranial internal carotid artery dissection in patients presenting with ischemic stroke at the onset, changes are more often observed relatively shortly after the onset at the site of dissection on MRA and DSA compared with atherosclerotic changes, and the diagnosis may be achieved by repeating these examinations. 5,7,9) It is necessary to comprehensively diagnose the disease by serial imaging studies and evaluate the patient background including the age and the presence or absence of headache, and symptoms are more important rather than the images at the onset.…”

“…1,2) In the acute period, approaches including conservative treatment and endovascular treatment have been reported, but no standard approach has been established due to the scarcity of patients and lack of a large amount of data. [1][2][3][4] In this paper, we report two cases of intracranial internal carotid artery dissection presenting with ischemic stroke with a review of the literature.…”

Basi-parallel Anatomical Scanning Magnetic Resonance Imaging in Patients With Bilateral Vertebrobasilar Artery Dissections -Case Report-

“…17,21) The incidence of rebleeding and the mortality rate are higher in patients who developed SAH compared to patients with unruptured VA dissection, 7) whereas favorable outcomes occur in patients with unruptured VA. 3,16,22) However, the pathogenesis and exact natural history of VA dissection remain unclear. Basiparallel anatomical scanning (BPAS) magnetic resonance (MR) imaging is a simple MR imaging technique that modifies surface anatomical scanning and can depict the surface appearance of the intracranial VA. 4,12,13) We describe a case of bilateral VA dissections in which the temporal course of the dissected arteries was serially evaluated using BPAS-MR imaging in addition to MR angiography and three-dimensional computed tomography (3D-CT) angiography, and discuss the use of BPAS-MR imaging in conjunction with conventional imaging tools to achieve accurate diagnosis and evaluation of the temporal course of the disease in patients with VA dissection.…”