Abstract
We report the case of a patient with subarachnoid hemorrhage due to contralateral vertebral artery (VA) dissection two years after spontaneous occlusion of ipsilateral VA dissection. A 44-year-old man suffered a headache and visited our department. Magnetic resonance (MR) imaging showed dissection of the left VA. Six months later, the VA appeared spontaneously and asymptomatically occluded on MR imaging. The right VA exhibited no abnormal findings. MR imaging at 23 months after the confirmation of left VA occlusion showed no changes in bilateral VAs. Two months later, the patient suffered sudden headache and subsequent disturbance of consciousness due to subarachnoid hemorrhage. Cerebral angiography demonstrated a fusiform aneurysm at the right VA proximal to the origin of the posterior inferior cerebellar artery and occlusion in the left VA. Trapping of the lesion in the right VA following arterial reconstruction through craniotomy was planned. However, the patient developed pneumonia and died of recurrent subarachnoid hemorrhage. The mean interval between occlusion of ipsilateral VA dissection and rupture of a contralateral VA dissection is reportedly within two weeks. The present case suggests that dissection may develop and subsequently rupture in the contralateral VA even more than two years after occlusion of an ipsilateral VA dissection.
