-Case Reports-

Anterior Cerebral Artery Dissection Presenting Subarachnoid Hemorrhage and Cerebral Infarction

Kentaro Suzuki, Masahiro Mishina, Seiji Okubo, Arata Abe, Satoshi Suda, Masayuki Ueda and Yasuo Katayama

Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School Hospital

A 35-year-old man presented with simultaneous occurrence of subarachnoid hemorrhage (SAH) and cerebral infarction (CI) caused by anterior cerebral artery (ACA) dissection. He complained of sudden onset of left frontal headache and his symptoms progressed to consciousness disturbance and right hemiparesis. Computed tomography and magnetic resonance imaging demonstrated SAH localized in the left interhemispheric fissure and CI in the territory of the left ACA. Right carotid angiography demonstrated a long double lumen sign at the left A2 to A4 segment of the left ACA, leading to a diagnosis of the combined type of CI and SAH caused by ACA dissection. Although many surgeons have previously tried to perform endovascular treatment, we selected only medication in this case, and his neurological findings gradually improved. Only 9 cases including the present case presented with simultaneous occurrence of SAH and CI caused by ACA dissection. Many of these patients showed stenosis with dilatation of ACA on carotid angiography. The prognoses of these patients were good. However, many SAH patients with dissecting aneurysm had poor prognoses. To improve the strategy for managing ACA dissection, we need to accumulate a greater number of such cases in the future. We also recommend that angiography should be performed in the patients with ACA dissection.

J Nippon Med Sch 2012; 79: 153-158

Keywords
anterior cerebral artery, dissection, simultaneous, cerebral infarction, subarachnoid hemorrhage

Correspondence to
Kentaro Suzuki, MD, Divisions of Neurology, Nephrology and Rheumatology, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kentarow@nms.ac.jp

Received, August 11, 2011
Accepted, October 11, 2011