J Cerebrovasc Endovasc Neurosurg.  2014 Jun;16(2):119-124. 10.7461/jcen.2014.16.2.119.

Two Cases of Subarachnoid Hemorrhage from Spontaneous Anterior Cerebral Artery Dissection : A Case of Simultaneous Hemorrhage and Ischemia Without Aneurysmal Formation and Another Case of Hemorrhage with Aneurysmal Formation

• Im TS
• Lee YS
• Suh SJ
• Lee JH
• Ryu KY
• Kang DG

• KMID: 1963180
• DOI: http://doi.org/10.7461/jcen.2014.16.2.119

Abstract

Spontaneous anterior cerebral artery (ACA) dissection, although extremely rare, is often associated with severe morbidity and mortality. It could lead to cerebral hemorrhage, ischemic stroke, or, rarely, combination of hemorrhage and ischemia due to hemodynamic changes. Prompt and accurate diagnosis is essential for determining the appropriate management. However, the optimal treatment for ACA dissection remains controversial. Herein, we report on two rare cases of subarachnoid hemorrhage (SAH) caused by ACA dissection; a case presenting with simultaneous SAH and infarction without aneurysmal formation and another case presenting with SAH with fusiform aneurysmal formation. A review of the related literature is provided, and optimal treatments for each type of dissection are suggested.

Keyword

Anterior cerebral artery; Dissection; Infarction; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Anterior Cerebral Artery*
Cerebral Hemorrhage
Diagnosis
Hemodynamics
Hemorrhage*
Infarction
Ischemia*
Mortality
Stroke
Subarachnoid Hemorrhage*

Figure

• 

  Fig. 1 Initial brain computed tomography (CT) scan shows an obvious subarachnoid hemorrhage (SAH) at the anterior interhemispheric fissure and left superior frontal sulcus (A). Anteroposterior (AP) view (B) and lateral view (C) of the left internal carotid angiogram show abrupt luminal tapering (black arrows) of the left distal anterior cerebral artery (ACA) with compromised distal flow. Diffusion-weighted magnetic resonance imaging (MRI) shows an acute cerebral infarction in the left ACA vascular territory (D). AP view (E) and lateral view (F) of the left internal carotid angiogram after 33 months show complete luminal healing (black arrowheads) without any aneurysmal formations.

• 

  Fig. 2 Initial brain CT scan shows a SAH at the sylvian fissures and anterior interhemispheric fissure (A). Left anterior oblique view (B) of the right internal carotid angiogram shows a fusiform aneurysm (black arrow) on the right side wall of the A2 segment of azygous ACA. The distal ACA flow remains patent without stenosis or occlusion. Note a suspicious double lumen sign at the base of fusiform dilatation. Post-procedural angiogram (C) shows a tiny remnant (black arrowhead) at the proximal portion. Follow-up angiogram after two weeks shows complete obliteration of the aneurysm with preservation of the parent artery (D).

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