Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report

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.

Intracranial Fusiform Aneurysms: It's Pathogenesis, Clinical Characteristics and Managements

“…Various etiological factors for fusiform aneurysms have been proposed, including atherosclerosis, vessel dissection and association with other diseases such as von Recklinghausen's disease, fibromuscular dysplasia, systemic lupus erythematosus and various collagen-associated vascular diseases 4,6,30,34) . Based on the radiological, operative and histopathology findings in this study, vessel dissection was the leading cause, followed by atherosclerosis and collagen disease or unknown factors.…”

“…Dissection has been proposed as the main underlying cause of fusiform aneurysms and most commonly involves the posterior circulation, especially vertebral and basilar arteries 1,3,[5][6][7][8][9][10]15,16,19,20,[24][25][26]32,35) However, typical cases of dissecting aneurysm in the posterior circulation were excluded in this study. Dissecting aneurysms can originate in any regions of the anterior circulation, such as the ICA 1,29) , MCA 2,4,6,10,[13][14][15][16]22,26,30) , the ACA 3,10,[16][17][18]24,27,30,32,35) and rarely in the anterior choroidal artery 21) . The MCA is the most common 6) .…”

Saccular Aneurysm of the Accessory Middle Cerebral Artery. Case Report.

“…His concepts have been widely accepted by other authors. [2][3][4][5][8][9][10][11][12]14,15) The incidence of the accessory MCA is 0.3% to 2.7% in autopsy series. 1,7) The angiographic incidence of accessory MCA is 0.32%.…”

“…There have been only nine previous reports of accessory MCA aneurysms, including seven saccular aneurysms arising from the origin of the accessory MCA. [2][3][4][5]8,[10][11][12]14) We present another case of a ruptured saccular aneurysm arising from the origin of the accessory MCA.…”

Transient Ischemic Attack Due to Dissection of the Middle Cerebral Artery. Case Report.

“…The characteristic angiographic findings are double lumens, narrowing and dilating, pooling, slow filling, intimal flap, and filling defect. [5][6][7][8] The only reliable diagnostic sign is the double lumen, in which both true and false lumens are seen, but the double lumen does not always appear. Angiography showed wall irregularity and double lumen in our case, which are compatible with dissection.…”