Indication and Pitfall of Endovascular Treatments for Unruptured Dissecting Aneurysms

Subintimal hemorrhage of an aneurysm in the absence of subarachnoid hemorrhage may be conceptually considered an aneurysm in the process of rupturing. Thus, aneurysms found in the acute setting may benefit from further workup, such as magnetic resonance imaging or highly selective angiographic evaluation of the aneurysm itself. Timely surgical intervention may prevent otherwise imminent rupture into the subarachnoid space.

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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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Indication and Pitfall of Endovascular Treatments for Unruptured Dissecting Aneurysms

Cited by 4 publications

References 26 publications

Ruptured Vertebral Artery Dissection Treated with Endovascular Intervention

Ruptured Vertebral Artery Dissection Treated with Endovascular Intervention

Subintimal Hemorrhage in an Unruptured Superior Cerebellar Artery Aneurysm

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

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