A Case of Ruptured Middle Cerebral Artery Aneurysm with Cervical Carotid Artery Dissection

Abstract

Herein, we report a case of a 47-year-old man with a ruptured middle cerebral artery aneurysm with cervical carotid artery dissection. The patient initially experienced posterior cervical pain after returning home from work. The next day, he was found in a state of impaired consciousness, and was transported to our hospital by ambulance. The patient was diagnosed with a ruptured middle cerebral artery aneurysm, which was clipped on Day 0. Magnetic resonance imaging after treatment revealed stenosis of the left internal carotid artery (ICA) and infarction of the left insular cortex. We suspected a relationship between cerebral infarction and stenosis of the ICA. Digital subtraction angiography on Day 11 revealed a “string sign” in the cervical portion of the left ICA; thus, the patient was diagnosed with internal carotid artery dissection. Because stenosis did not improve, carotid artery stenting was performed on Day 32. The patient was discharged from our hospital with a modified Rankin Scale score of 0 on Day 44. If subarachnoid hemorrhage is accompanied by posterior cervical pain, the possibility of carotid artery dissection should be considered.