Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm

Abstract

An aneurysmal dissection of a right middle cerebral artery (MCA) branch is described in a 56-year-old woman. The abnormality was an incidental finding on computerized tomography and subsequently appeared on magnetic resonance imaging performed to evaluate the patient for subjective pulsatile tinnitus. The intracranial aneurysm was documented to have enlarged on serial angiography over a 6-week interval. Treatment was believed to be necessary because of the unknown etiology of the aneurysm, with the differential diagnosis including mycotic or neoplastic aneurysm with a risk of hemorrhage. The lesion was excised and flow to the distal MCA branch was preserved with an anastomosis of the superficial temporal artery to the MCA. The aneurysm, which developed at the level of the sylvian fissure, proved on pathological study to be related to a focal dissection of the MCA branch. The radiographic appearance and pathological findings are presented. Focal dissection must henceforth be included in the differential diagnosis of peripheral cerebral artery aneurysms.

Dissecting Aneurysm of the Anterior Temporal Artery -Case Report-

“…[1][2][3]5,6,8,9,11,14,[17][18][19][20] Study of the mechanisms of ruptured/unruptured arterial dissection using immunohistochemical findings of lysyl oxidase (Lox) and matrix metalloproteinases (MMPs) in multiple dissecting aneurysms demonstrated that Lox1, MMP-2, and MMP-9 were remarkably expressed in hypertrophic media outside the intima in ruptured dissecting aneurysms, but were expressed in the intima and inside hypertrophic media in unruptured dissecting aneurysms. 17) Our patient was hospitalized with ischemia.…”

“…These lesions tend to enlarge gradually and rupture eventually. 8,14) Based on a distal MCA dissecting aneurysm that resulted in intracerebral hemorrhage 4 years after its non-hemorrhagic onset, surgical treatment was strongly recommended if ectatic components are identified. 8) In our patient, preoperative angiography revealed aneurysmal dilatation and a thrombosed mass.…”

“…7,10) Arterial dissection was involved in the development of aneurysms unrelated to branching zones, but the specific cause remained unidentified in most patients with intracerebral dissecting aneurysms. 12,14) Spontaneous middle cerebral artery (MCA) dissection is relatively rare, and is usually located in the M1 portion. 15) True anterior temporal artery (ATA) dissecting aneurysms are extremely rare, with only one reported case.…”

Acute Surgery for Ruptured Dissecting Aneurysm of the M3 Portion of the Middle Cerebral Arteryda-Case Report-

“…Dissecting aneurysms in the middle cerebral artery (MCA) are relatively rare, with 26 reported cases of spontaneous dissecting aneurysms of the MCA, [1][2][3][4][5][6][7][8][9]11,[14][15][16][17][18][19] of which only three were located on the M 3 portion. 6,15,17) We describe a rare case of dissecting aneurysm of the M 3 portion treated through resection and anastomosis of the superficial temporal artery (STA) to the MCA.…”

Transient Ischemic Attack Due to Dissection of the Middle Cerebral Artery. Case Report.

“…10) The typical initial clinical symptoms are sudden appearance of headache and the disturbance of consciousness with hemispheric functional loss. 9) Intracranial dissections of the anterior circulation usually occur in young people. 5,10) Most patients with dissections of the posterior circulation present with subarachnoid hemorrhage.…”