Abstract
A case of anterior cerebral artery dissecting aneurysm presenting subarachnoid hemorrhage and cerebral infarction at the same time is reported.
A 62-year-old male suffered from vomiting and speech disturbance. On admission, however his consciousness was clear, mild dysarthria and right hemiparesis were recognized and a CT scan revealed subarachnoid hemorrhage in the interhemispheric fiissure and the left parietal region. A CT scan and MRI taken on the next day demonstrated cerebral infarction in the left anterior cerebral artery perfusion area. The first angiogram showed small dilataion of a part of the left A2 portion only. Two weeks later the second angiogram showed segmental narrowing of the left A2 and A3 portion following the bulbous dilatation of the lumen on the left A2 portion, which suggested a dissecting aneurysm. We performed side-to-side anastomosis between the bilateral A3 portion and trapping of the bulbous dilatation to prevent reattack. The postoperative course was not only uneventful, but the right hemiparesis improved remarkably.
The anterior cerebral artery dissecting aneurysm presenting both subarachnoid hemorrhage and cerebral infarction is very rare. It is believed this is the first case which received anastomosis and trapping for anterior cerebral artery dissecting aneurysm.
