A case of dissecting aneurysm involving solely anterior cerebral artery.

Two rare cases of dissections which involve the anterior cerebral artery (ACA) are reported. A 58-yearold woman presented with a ruptured dissecting aneurysm manifesting as sudden onset of severe headache and consciousness disturbance followed by aphasia, right hemiparesis, paresis of the left lower extremity, and choreoathetotic movements of the upper arms and face. Computed tomography and angiography revealed subarachnoid hemorrhage due to a dissecting aneurysm at the left A 1 segment. The dissecting aneurysm was trapped surgically on the day of onset. Her neurological deficits disappeared within a month. A 39-year-old woman experienced continuous dull headache from the day before onset, and then suffered right hemiparesis. Magnetic resonance (MR) imaging revealed cerebral infarction at the left globus pallidus. Angiography and MR imaging revealed a dissecting aneurysm at the left A 1 segment and occlusion of the left Heubner's artery. She received conservative treatment and her neurological findings were improved. Dissections or dissecting aneurysms involving the ACA can be classified into three types: Extension of a dissection to the ACA from the internal carotid artery, dissection at the A 1 segment, and dissection at the A 2 -A 4 segments. These types of dissection have distinct uniform clinical features.

Section: Discussionmentioning

confidence: 99%

Dissecting Aneurysms at the A1 Segment of the Anterior Cerebral Artery. Two Case Reports.

Hirao

Okamoto

Watanabe

et al. 2001

“…5,6,18,19,21,33,34,37,49) In our review, 6 cases were associated with these possible causative factors (FMD in 2, 18,19) migraine in 2, 6,18) and GBS, 33) PN, 6) polycystic kidney, 42) past history of subarachnoid hemorrhage, 19) and resection of arteriovenous malformation 1) in one each), and 33 cases had a medical history of hypertension 4,6,7,9,11,13-15,17,19-21,23, 26,28,30,35,39,[41][42][43]45,48) (Table 1). The other medical associations were asthma, 23) hyperlipidemia, 23) atrial fibrillation, 32) and diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

“…29) A total of 82 cases of nontraumatic dissecting aneurysms have been described including the present 3 cases (Table 1). 35,36,[38][39][40][41][42][43][44][45][46][47][48][49] Among these patients, 45 presented with infarction, 26 suffered hemorrhagic events, and 11 experienced both ischemia and hemorrhage. The mean age of the patients was 50.3 years (range, 22-72 years), and men (n ＝ 46) were affected to a greater extent than women (n ＝ 36).…”

Section: Discussionmentioning

confidence: 99%

“…1,5,22,25,40,49) We describe 3 cases of revascularization of dissecting aneurysm located in the ACA, and review 79 previously reported cases of nontraumatic dissecting aneurysm confined to the ACA. 35,36,[38][39][40][41][42][43][44][45][46][47][48][49] Case Reports Case 1: A 56-year-old woman experienced transient weakness in her left lower extremity while riding a bicycle and was consequently transferred to our institution. She was alert and responded to commands promptly.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Revascularization for Anterior Cerebral Artery Dissecting Aneurysms -Three Case Reports-

Uozumi

Katoh

Tsuzuki

et al. 2010

We describe three rare cases of dissecting aneurysms in the anterior cerebral artery (ACA) treated by surgical reconstruction, and reviewed 79 previously reported cases with the ACA dissecting aneurysm. We found that 35 (77.8%) of 45 patients with ischemic event and 15 (40.5%) of 37 patients with hemorrhagic event were treated conservatively, with 11.4% (4/35 cases) and 13.3% (2/15) risk of bleeding and rebleeding, respectively. Furthermore, half of these patients died. The other 32 patients were treated surgically, and their outcome was favorable, especially after surgical reconstruction. Simultaneous treatment of both hemorrhagic and ischemic events is essential. We recommend early treatment with revascularization for patients with ACA dissection that has hemorrhaged and for patients presenting with signs of clinical deterioration with ischemic event.

“…Dissecting aneurysms occur most frequently in the vertebrobasilar arteries (VBAs), 36) and are relatively rare in the anterior circulation, especially in the anterior cerebral artery (ACA). 1,4-10,12,14-18,20,21,23,25, 26, 29,30,32,33,37,38) Spontaneous intracranial dissecting aneurysms usually develop as a single lesion, 34,36) whereas multiple spontaneous dissecting aneurysms of the ACA have not been reported. We describe a case of multiple spontaneous dissecting aneurysms of the ACA.…”

Section: Introductionmentioning

confidence: 99%

Anterior Cerebral Artery Dissections Manifesting as Cerebral Hemorrhage and Infarction, and Presenting as Dynamic Angiographical Changes. Case Report.

Sakamoto

Inagawa

Ikawa

et al. 2002

A 65-year-old woman presented with multiple dissecting aneurysms of the anterior cerebral artery (ACA) manifesting as hemiparesis on the right with dominance in the lower extremity. Computed tomography revealed hematoma in the left frontal lobe, corresponding to the area perfused by the callosomarginal artery. Initial angiography showed string sign and occlusion in the distal portion of the left callosomarginal artery and abnormal feeding suggesting double lumen of the A 2 portion of the left ACA. The patient was treated conservatively under a diagnosis of multiple spontaneous dissecting aneurysms of the left ACA. Repeat angiography on Day 8 showed improvement of the string sign and occlusion in the left callosomarginal artery, and change of the double lumen of the A 2 portion into string sign. Further angiography on Day 36 showed normalization of the left callosomarginal artery and improvement of the string sign in the A 2 portion. Multiple spontaneous dissecting aneurysms of the ACA are extremely rare. Serial angiography beginning in the early stage will be important for correct diagnosis.