J Korean Neurosurg Soc.  2013 Feb;53(2):115-117. 10.3340/jkns.2013.53.2.115.

Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections

• Park YK
• Yi HJ
• Lee YJ
• Kim YS

• KMID: 2190689
• DOI: http://doi.org/10.3340/jkns.2013.53.2.115

Abstract

Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subsequent stroke. In this setting, prompt treatment with stent-assisted endovascular embolization can be a reliable alternative to direct surgery. When multiple arterial dissections are coexistent, management strategy often became complicated. However, satisfactory clinical results can be obtained by acknowledging responsible arterial site with careful radiographic inspection and antiplatelet medication.

Keyword

Dissecting aneurysm; Subarachnoid hemorrhage; Cerebral infarction; Anterior cerebral artery; Endovascular embolization

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Aneurysm, Ruptured
Anterior Cerebral Artery
Cerebral Infarction
Constriction, Pathologic
Hemorrhage
Humans
Infarction
Stroke
Subarachnoid Hemorrhage

Figure

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  Fig. 1 Magnetic resonance images at admission show an acute ischemia of the left rostral corpus callosum in diffusion-weighted image (A) and apparent diffusion coefficient map (B). A fluid-attenuated inversion recovery image shows both infarction and hemorrhage of the left frontal convexity (C) and axial source image indicates hyperintense double lumen sign at the proximal anterior cerebral artery (white arrow) (D).

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  Fig. 2 Angiogram shows multifocal dissections at the left anterior cerebral artery (A), right vertebral artery (V3) (B) and right carotid bulb (C).

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  Fig. 3 After 4 months, angiogram shows superior elongation of the aneurysm sac and progressing stenosis along the anterior cerebral artery (ACA) (A). Postoperative angiogram shows complete filling of the aneurysm (B), and 6-month follow-up angiogram depicts no residual filling and straightening of the ACA due to a deployed stent (C).

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