Four Cases of Intracranial Vertebral Artery Dissecting Aneurysm Presenting with Headache and Neck Pain as the only Manifestation.

Summary:Intracranial arterial dissection is considered to be not a rare disease recently, but the natural history of this disease is not well known yet. In this study, we analyzed the serial changes of angiographical or MRI/MRA finding and the long-term outcome to clarify the treatment strategy in patients with non-hemorrhagic intracranial arterial dissection.Among 120 consecutive patients with arterial dissection of the vertebrobasilar system, 44 (37%) presented with ischemia and/or headache. Ages ranged from 27 to 77 years (mean: 49.3 / 11.0 years).Thirty-nine patients were managed conservatively and an antiplatelet agent was given in 10 because of history of myocardial or brain ischemia. Only 5 were treated surgically because the lesion had been enlarged or extended on the follow-up study. The vertebral artery was most commonly affected. On the initial angiographical or MRI/MRA finding, fusiform dilatation (43%) was the most frequent finding, followed by pearl and string sign (32%). In the serial changes of the findings, no change (43%) was most common, followed by improvement (37%).Among 39 patients who presented with ischemia, 8 (21%) had subsequent symptoms (ischemia in 7, subarachnoid hemorrhage in 1). Recurrence tended to occur more frequently in the antiplatelet group.The follow-up period ranged from 1 to 17 years (mean: 5.8 / 4.1 years). The long-term outcomes were generally favorable. Thirty-three patients (85%) recovered well and 3 died among the 39 conservatively managed patients. Four of 5 patients achieved good recovery and returned to work in the surgically treated group. In addition, the outcomes in the antiplatelet group did not differ significantly from those without the above agents.

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Clinical Study of Vertebral Dissecting Aneurysm Manifesting as Subarachnoid Hemorrhage Following Head-nuchal Pain

Ikeda¹,

Oshiro²,

Sakamoto³

et al. 2007

Surg. Cereb. Stroke

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We report 3 patients who developed subarachnoid hemorrhage (SAH) from the vertebral dissecting aneurysm after head-nuchal pain. All 3 patients developed sudden head-nuchal pain, at the onset of which no subarachnoid hemorrhage was observed on CT (n 2) or on CT and MRI (n 1). Subsequently, SAH occurred within 1 or 2 days. All 3 patients were men aged 46 to 55 years, and had a Hunt and Kosnik Grade of III (n 1) or V (n 2) at admission. Vertebral angiography revealed aneurysmal dilatation with narrowing, but no posterior inferior cerebeller artery (PICA) involvement in any of the patients. All patients were treated for proxymal occlusion, including aneurysm, using GDC coils. In 1 patient, decompressive craniectomy was performed due to progression of a thrombosis to the PICA, and cerebeller and brain stem infarction. The Glasgow Outcome Scale (GOS) was good recovery in 2 patients. The patient who underwent decompressive craniectomy presented quadriplegia and had a score of Vegetative State. Although dissecting vertebral aneurysm presenting with head-nuchal pain and/or ischemic symptoms generally carry a favorable prognosis, we should be careful that it might associated with SAH as shown in the present case.

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Four Cases of Intracranial Vertebral Artery Dissecting Aneurysm Presenting with Headache and Neck Pain as the only Manifestation.

Cited by 5 publications

References 24 publications

Management of Intracranial Vertebral Artery Dissections Presenting with Isolated Pain

Management of Intracranial Vertebral Artery Dissections Presenting with Isolated Pain

Treatment Strategy of Non-hemorrhagic Arterial Dissection in Vertebrobasilar System

Clinical Study of Vertebral Dissecting Aneurysm Manifesting as Subarachnoid Hemorrhage Following Head-nuchal Pain

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