1984 Volume 24 Issue 5 Pages 343-348
A case of dissecting aneurysm of the vertebro-basilar artery diagnosed angiographically and histologically is reported.
A 31-year-old female suddenly developed severe headache and vomiting. On admission, 9 hours later, the patient was somnolent, and signs of diffuse brain stem lesion were manifest. Cerebrospinal fluid, craniogram, and computerised tomography scan showed no abnormal findings. Left vertebral angiography showed intimal separation of the basilar artery as a “double lumen'” on lateral projection. The patient was given conservative treatment, but died 12 days later of brain stem hemorrhage. Pathological examination showed that the dissection occurred twice: the first subintimal dissection started at the left vertebral artery 15 mm proximal to the vertebral union, and extended to the proximal portion of the left anterior inferior cerebellar artery; the second dissection occurred in the basilar artery and caused the brain stem hemorrhage.
The prognosis for dissecting aneurysm of the vertebro-basilar system, especially involving the basilar artery, is very poor, and the authors think that surgical procedure, such as ligation, trapping, or anastomosis, in the early stage, based on a correct angiographical diagnosis, is most beneficial.
