Neurological Surgery No Shinkei Geka Volume 29, Issue 1 (January 2001)

Serial Angiographical Changes of a Ruptured Dissecting Vertebral Aneurysm Yasunobu NAKAI 1 , Susumu YASUDA 2 , Akira MATSUMURA 2 , Yuji MATSUMARU 2 , Tadao NOSE 2 1Department of Neurosurgery, Hata Hospital 2Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba Keyword: cerebral angiography , dissecting aneurysm , subarachnoid hemorrhage , vertebral artery pp.71-74
Published Date 2001/1/10
  • Abstract
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A 54-year-old woman presented a subarachnoid hemorrhage from a ruptured dissecting aneurysm on the right vertebral artery. A right vertebral angiogram revealed a fusiform dilatation distal to the right post- erior inferior cerebellar artery and “pseudo lumen” was observed in a delayed arterial phase. Conservative treatment was carried out, and the patient condition gradually improved. An angiographical examination for planned endovascular treatment 46 days after the onset, revealed the normalization of the formerly di- lated caliber of the right vertebral artery with only a minor luminal irregularity. However, 83 daysafter theonset, right vertebral angiogram showed reappearanceof the fusiform dilatation. The right vertebral angio-gram obtained 204 days after the onset showed that the dilated segment of the dissecting aneurysm hadbecome normalized to a slight degree. The serial angiographical changes of the dissecting site might havebeen due to regression and organization following transient thrombosis of intramural hematoma. Suchdrastic changes within a short period have not been reported yet. In conclusion, careful repeated follow-upis recommended in monitoring aneurysmal formation during. the early to chronic phase after rupture of adissecting aneurysm. The repetition of angiography is important, because later, if angiography has beenperformed only once, aneurysmal dilatation may be overlooked. One has to be aware of such changes, be-cause such changes may alter the clinician's decision about treatment, as they did in our case.

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Neurological Surgery 脳神経外科
29巻1号 (2001年1月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院