Hemorrhagic intracranial distal (cortical) dissections: five cases and a literature review

Abstract

Objective: To describe and analyze five cases of symptomatic intracranial spontaneous cortical dissections and a review of the literature relating to this disorder. Method: Retrospective analysis of patients undergoing investigation for intracranial hemorrhage. Data were compiled from the medical file and PACS of the Nancy University Hospital. Results: Of 350 patients who underwent investigation for spontaneous intracranial hemorrhage, five patients (four women) harbored intracranial distal dissections, with no evidence of infection, trauma, arterial hypertension, vasculitis. The patients age ranged from 35 to 77 years (mean age 50.8 years). No patient presented with a poor grade SAH (Hunt and Hess grade IV or V). All patients presented with headache. The localization of the vessel abnormality was equally distributed between the anterior and posterior circulation. All patients, except one, harbored an aneurysmal sac angiographically detectable. Conclusion: Dissecting aneurysms of the intracranial distal/cortical arteries are exceedingly rare vascular lesions that produce neurologic symptoms related to their topography and hemorrhagic or ischemic nature. In the aneurysmal forms, the treatment in an urgent fashion may be considered if we consider the risk of re-hemorrhage. The first-choice treatment is coil occlusion of the involved artery at the level of the dissection.