Subarachnoid Hemorrhage from Spontaneous Dissection of the Anterior Cerebral Artery

Thines, L.; Zaïri, Fahed; Taschner, Christian; Leclerc, Xavier; Lucas, Christian; Bourgeois, Philippe; Lejeune, J.-P.

doi:10.1159/000095383

Cited by 20 publications

(20 citation statements)

References 22 publications

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“…1,2,7,10,13,14) Intracranial dissection that involves the ACA is extremely rare, but recent advances in diagnostic modalities such as DSA and MR imaging have detected such dissection more frequently. 3,4,8,9,11,12,15) An angiographic study of ACA dissection found arterial stenosis without dilatation occurred mainly in ischemic cases, whereas stenosis with dilatation occurred predominantly in hemorrhagic cases. 9,11) Intracranial dissection can be divided into two types on the basis of the histological findings.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Occurrence of Subarachnoid Hemorrhage and Cerebral Infarction Caused by Anterior Cerebral Artery Dissection Treated by Endovascular Trapping -Case Report-

Inoue

Fujimura

Matsumoto

et al. 2010

Neurol. Med. Chir.(Tokyo)

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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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Section: Discussionmentioning

confidence: 99%

“…3,4,8,9,11,12,15) Spontaneous intracranial dissection is often associated with severe morbidity and mortality, and causes subarachnoid hemorrhage (SAH), intracranial hemorrhage, or ischemic stroke. 9,11) Only three cases presenting with both SAH and infarction have been reported.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Occurrence of Subarachnoid Hemorrhage and Cerebral Infarction Caused by Anterior Cerebral Artery Dissection Treated by Endovascular Trapping -Case Report-

Inoue

Fujimura

Matsumoto

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…Hypertension and atherosclerosis may be risk factors (13). Intracranial artery dissection may be related to connective tissue diseases affecting the arterial wall like fibromuscular dysplasia or autosomal dominant polycystic kidney disease which have been reported to be other possible causes (11). Regardless of the location, haemorrhagic forms occur in patients harbouring significant dilatation or fusiform aneurysm while ischemic forms occur in the presence of a stenosis.…”

Section: Aboukais R Et Al: Intracranial Dissecting Aneurysmmentioning

confidence: 99%

“…Dissecting aneurysms revealed by haemorrhage can be effectively treated conservatively with a good outcome and a low rate of rebleeding. Surgical management is recommended if there is a high risk of rebleeding (11,12) (rebleeding under conservative treatment, growing aneurysm, giant aneurysm or uncontrolled hypertension). Many surgical procedures have been proposed such as wrapping, trapping with or without bypass surgery or clipping of the aneurismal bulge (8).…”

Section: Treatmentmentioning

confidence: 99%

Radiological pitfalls of a large intracranial dissecting aneurysm

Aboukaïs¹,

Zaïri²,

Bourgeois³

et al. 2013

Turkish Neurosurgery

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We report the case of a large dissecting aneurysm of the anterior cerebral artery revealed by cerebral infarction in 38-year-old man. The volume and aspect of the aneurysm initially led us to the diagnosis of saccular aneurysm. Given the complete thrombosis, the risk of bleeding was low and antithrombotic therapy was started. Surgery could be discussed later. However radiological monitoring by MRI (magnetic resonance imaging) showed a rapid decrease in volume of the aneurysm. The final angiography found an aspect of stenosis followed by a little arterial dilatation. The diagnosis of dissecting anterior cerebral aneurysm was a posteriori established.KEywOrds: Dissecting aneurysm, Ischemic stroke, Haemorrhage, Angiography ÖZ 38 yaşında bir erkekte serebral infarktüsle ortaya çıkan anterior serebral arterin büyük disekan anevrizması olgusunu bildiriyoruz. Anevrizmanın büyüklüğü ve yeri başlangıçta sakküler anevrizma tanısı düşündürdü. Tam tromboz olduğu dikkate alındığında kanama riski düşüktü ve antitrombotik tedavi başlandı. Cerrahi seçeneği daha sonra değerlendirilecekti. Ancak manyetik rezonans görüntüleme (MRG) ile radyolojik izleme anevrizmanın hacminde hızlı bir azalma gösterdi. Son anjiyografi bir miktar stenoz ve sonrasında biraz arteriyel dilatasyon buldu. Sonradan disekan anterior serebral anevrizma tanısı kondu.

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“…1,5,22,25,40,49) We describe 3 cases of revascularization of dissecting aneurysm located in the ACA, and review 79 previously reported cases of nontraumatic dissecting aneurysm confined to the ACA. 35,36,[38][39][40][41][42][43][44][45][46][47][48][49] Case Reports Case 1: A 56-year-old woman experienced transient weakness in her left lower extremity while riding a bicycle and was consequently transferred to our institution. She was alert and responded to commands promptly.…”

Section: Introductionmentioning

confidence: 99%

Revascularization for Anterior Cerebral Artery Dissecting Aneurysms -Three Case Reports-

Uozumi

Katoh

Tsuzuki

et al. 2010

Neurol. Med. Chir.(Tokyo)

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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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Subarachnoid Hemorrhage from Spontaneous Dissection of the Anterior Cerebral Artery

Cited by 20 publications

References 22 publications

Simultaneous Occurrence of Subarachnoid Hemorrhage and Cerebral Infarction Caused by Anterior Cerebral Artery Dissection Treated by Endovascular Trapping -Case Report-

Simultaneous Occurrence of Subarachnoid Hemorrhage and Cerebral Infarction Caused by Anterior Cerebral Artery Dissection Treated by Endovascular Trapping -Case Report-

Radiological pitfalls of a large intracranial dissecting aneurysm

Revascularization for Anterior Cerebral Artery Dissecting Aneurysms -Three Case Reports-

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