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A case of middle cerebral artery occlusion caused by dissecting aneurysm Yoshihiko FU 1,5 , Masaki KOMIYAMA 2 , Tsuyosi INOUE 3 , Kenji OHATA 4 , Yoshimi MATSUOKA 4 , Akira HAKUBA 4 1Department of Neurosurgery, Tsukazaki Hospital 2Department of Neurosurgery, Osaka City General Hospital 3Department of Neurosurgery, Tane General Hospital 4Department of Neurosurgery, Osaka City University Medical School Keyword: dissecting aneurysm , fibrinolysis , middle cerebral artery , double lumen , string and pearl sign pp.955-959
Published Date 1996/10/10
DOI https://doi.org/10.11477/mf.1436901290
  • Abstract
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We reported a case of middle cerebral artery occlu-sion caused by a dissecting aneurysm that was success-fully treated by intra-arterial fibrinolysis. A 38-year-old man suddenly developed left hemiparesis and became confused. He was transferred to our hospital one hour and 27 minutes after the ictus. Right carotid angiogram (CAG) revealed aneurysmal dilatation of the horizontal portion of the middle cerebral artery and occlusion of the anterior trunk. Twelve million IU of tissue plasmi-nogen activator was injected to fibrinolyze the throm-bus of the occlusion site through a microcatheter. After this, the patient became alert and hemiparesis dis-appeared. It took three hours and 30 minutes to gain recanalization after the ictus. Right CAG obtained the next day demonstrated the patency of the anterior trunk and the characteristic finding of the dissecting aneurysm viz “double lumen” as a result of fibrinolysis of the thrombus in the false lumen. Right CAG obtained two weeks later demonstrated “string and pearl sign” instead of the “double lumen” as a result of partial thrombosis in the false lumen. Follow-up CAG obtained nine months after the ictus demonstratedmarked reduction of the aneurysmal size as the result of progressing thrombosis of the false lumen. The char-acteristic angiographic findings of the dissecting aneu-rysm such as “double lumen” and “string and pearl sign” seemed to be mostly influenced by the status of the thrombus in the false lumen. In case of major cere-bral arterial occlusion caused by the embolus or throm-bus from the dissecting aneurysm, intra-arterial fibri-nolysis seems to be a possible treatment modality, even though it is accompanied by the risk of giving rise to subarachnoid hemorrhage.


Copyright © 1996, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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