J Cerebrovasc Endovasc Neurosurg.  2016 Sep;18(3):271-275. 10.7461/jcen.2016.18.3.271.

Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

• Lee MH
• Kim SU
• Lee DH
• Kim YI
• Cho CB
• Yang SH
• Kim IS
• Hong JT
• Sung JH
• Lee SW

• KMID: 2355653
• DOI: http://doi.org/10.7461/jcen.2016.18.3.271

Abstract

Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.

Keyword

Convexal subarachnoid hemorrhage; Ischemic stroke; Antiplatelet drug; Computed tomographic angiography

MeSH Terms

Angiography
Aspirin
Cerebral Infarction*
Emergency Service, Hospital
Female
Follow-Up Studies
Humans
Infarction
Middle Aged
Platelet Aggregation Inhibitors
Stroke
Subarachnoid Hemorrhage*
Aspirin
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1 (A) Computed tomography scan of the patient showing subarachnoid hemorrhage (black arrow) on left frontal convexity. (B) CT angiography shows that both A2 segments were mild focal stenosis (white arrow). (C) Diffusion-weighted images shows a high intensity area in the territory of left anterior cerebral artery. (D) Brain SPECT with Tc-99 m HMPAO shows a small area of decreased perfusion at left frontal area. CT = computed thmography; SPECT = single-photon emission computed tomography; HMPAO = hexamethylpropylene amine oxime; Lt = left; Rt = Right.

• 

  Fig. 2 (A) Computed tomography shows that low intensity of previous ACA infarction territory (black arrow) and no high intensity presenting SAH on left frontal convexity. (B) and (C) there is no evidence of acute infarction in DWI and hemorrhagic transformation in SWI. ACA = anterior cerebral artery; SAH = subarachnoid hemorrhage; DWI = diffusion-weighted images; SWI = susceptibility weighted imaging.

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