Neurological Surgery No Shinkei Geka Volume 44, Issue 3 (March 2016)

Anterior Communicating Artery Dissection Presenting with Subarachnoid Hemorrhage and Cerebral Infarction Yasushi OGASAWARA 1 , Yoshitaka KUBO 1 , Takahiro KOJI 1 , Yuiko SATO 1 , Shunrou FUJIWARA 1 , Kuniaki OGASAWARA 1 1Department of Neurosurgery, Iwate Medical University Keyword: anterior communicating artery , dissection , subarachnoid hemorrhage , cerebral infarction pp.233-238
Published Date 2016/3/10
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 We describe the case of subarachnoid hemorrhage and cerebral infarction that developed simultaneously and was caused by suspected dissection of the anterior communicating artery. A 65-year-old woman presented with sudden onset of headache and nausea. Head computed tomography(CT)and magnetic resonance imaging revealed subarachnoid hemorrhage in the interhemispheric fissure and a spotty ischemic lesion in the right frontal cortex. Both, CT angiography and angiography with arterial catheterization showed an aneurysmal dilatation of the anterior communicating artery. A repeated CT angiography nine days later demonstrated enlargement of the aneurysmal dilatation. The patient underwent craniotomy under general anesthesia. Under the microscope, a thick hematoma was seen infero-dorsally from the anterior communicating artery. Two fenestrations of the anterior communicating artery were identified. After removal of the hematoma, a fusiform dilatation of the anterior communicating artery with a firm and reddish wall was confirmed. The lesion was coated with a teflon sponge and fibrin glue. The patient's postoperative course was uneventful. A follow-up CT angiography two months after surgery revealed shrinkage of the lesion, when compared with preoperative images.

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Neurological Surgery 脳神経外科
44巻3号 (2016年3月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院