Neurological Surgery No Shinkei Geka Volume 40, Issue 7 (July 2012)

Spontaneous Dissection of the Anterior Cerebral Artery that Simultaneously Presented with Cerebral Infarction and Subarachnoid Hemorrhage,Successfully Treated with Conservative Management: A Case Report Sho NANBARA 1 , Keisuke TSUTSUMI 2 , Hideaki TAKAHATA 2 , Takashi FUJIMOTO 1 , Ichiro KAWAHARA 2 , Tomonori ONO 2 , Keisuke TODA 2 , Hiroshi BABA 2 , Masahiro YONEKURA 2 1Residency Program,National Hospital Organization Nagasaki Medical Center 2Department of Neurosurgery,National Hospital Organization Nagasaki Medical Center Keyword: spontaneous arterial dissection , anterior cerebral artery , cerebral infarction , subarachnoid hemorrhage , simultaneous occurrence pp.635-642
Published Date 2012/7/10
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 We recently encountered a rare case of anterior cerebral artery dissection (ACAD) that accompanied fresh cerebral infarction (CI) and subarachnoid hemorrhage (SAH). An initial head CT showed a thin SAH in the interhemispheric cistern and cortical sulcus of the left frontal surface. Subsequent MRI performed 10 min after head CT scan revealed a fresh infarction in the left ACA region. MR-and digital subtraction angiograms demonstrated a dissection in the A2 portion of the left ACA with a leak of contrast media around the left A3 portion,suggesting that the bleeding occurred in a distal portion of the main dilation. Without anti-thrombotic therapy,the patient recovered without complications by blood pressure control and administration of brain-function protection therapies.

 We found 11 cases similar to the present case in the literature. All cases presented with lower-extremity dominant hemiparesis; however,sudden onset headache was rare. Blood pressure was not well-controlled in 4 out of the 6 known hypertensive cases. Main sites of dissection were located at the A2 portion in all cases except one A3 lesion,and extended to A3 in 2 cases. Conservative therapy led to favorable outcome in 8 cases,while 4 cases underwent surgical interventions for increasing risk of aneurysm rupture after initial observational therapies. Re-bleeding did not occur in any of the 12 cases reviewed. These data suggest that conservative treatment can be considered for an initial management of ACAD with simultaneous CI and SAH. More evidence needs to be accumulated to establish the optimal therapeutic approach for ACAD associated with CI and SAH.

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Neurological Surgery 脳神経外科
40巻7号 (2012年7月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院