Dissecting aneurysm of the intracranial vertebral artery with brainstem infarction followed by subarachnoid hemorrhage 10 hours after the ischemic onset: a case report

Abstract

We report a case of a dissecting vertebral aneurysm with subarachnoid hemorrhage after ischemic onset. A 57 year-old man was admitted because of sudden onset of posterior cervical pain, nausea and right hemiparesis. Magnetic resonance (MR) imaging showed a brain stem infarction and MR angiography showed a pearl and string sign of the right vertebral artery. Anticoagulant therapy was administered. Ten hours after the onset, the patient complained of severe headache and then became comatose. CT revealed subarachnoid hemorrhage. Right vertebral artery angiography showed a dissecting aneurysm and we embolized the right vertebral artery. He died 4 days after the onset of subarachnoid hemorrhage. Antiplatelet therapy and anticoagulant therapy for patients with dissecting vertebral aneurysm manifesting brain infarction are controversial because of the risk of following subarachnoid hemorrhage.