2010 Volume 32 Issue 4 Pages 390-395
We reported a case of a previously healthy 25-year-old woman who presented with sudden headache, speech disturbance, and left-sided weakness. Her brain diffusion weighted MR image (DWI) showed a small region of high signal intensity in the right claustrum and MR angiography (MRA) demonstrated segmental narrowing of the right terminal portion of the internal carotid artery (C1). Considering her clinical features and characteristic MR findings, we diagnosed her with ischemic stroke due to arterial dissection of the C1 and started conservative treatment.
After her admission, however, several ischemic attacks due to the dissecting C1 recurred. Follow-up DWI and MRA performed 4 days after the onset revealed new ischemic lesions in the right hemisphere and aneurysmal formation just proximal to the stenosis of the C1. Cerebral angiography performed on the same day showed a segmental narrowing of the C1 and an aneurysmal outpouching just proximal to the stenosis. By adjusting antithrombotics to the optimal dose on the basis of evaluation for the intracranial condition by repetitive DWI and MRA, with concerns about both the recurrence of ischemic attacks and occurrence of subarachnoid hemorrhage due to the rupture of the aneurysm, conservative treatment was continued and re-attack was prevented. In the follow-up examinations, stenosis and aneurysmal outpouching were repaired and the patient was discharged with no sequela on the 47th day. This case suggests that repetitive morphologic evaluation using MR images and prudent medical treatment are necessary to prevent recurrence of ischemic stroke due to intracranial arterial dissection combined with aneurysmal outpouching.
