Abstract
A 42-year-old male was brought to the hospital within 20 minutes of sudden onset of headache followed by loss of consciousness. No spontaneous respiration or cardiac activity was observed, and the patient was regarded as dead on arrival. However, vigorous resuscitative measures restored his sinus rhythm and spontaneous breathing and he eventually regained consciousness. Computed tomography revealed severe subarachnoid hemorrhage, and cerebral angiography showed a dissecting aneurysm of the vertebral artery. Proximal clipping of the vertebral artery was carried out 20 days after admission, and the postoperative course was uneventful.
The literature contains reports of 29 cases of a dissecting aneurysm of the vertebrobasilar system presenting with subarachnoid hemorrhage. One of the main clinical features in these patients was transient but severe suppression of respiration and impairment of consciousness. It should be emphasized that aggressive resuscitation is often rewarding even in patients considered dead on arrival. Also, this case confirmed that ligation of the vertebral artery proximal to a dissecting aneurysm is safe and effective, and is the treatment of choice in most cases.
