Abstract
Spontaneous arterial dissection in the anterior circulation is extremely uncommon. The natural course of this phenomenon is far from being understood, and the treatment is controversial. In this study, we report a case of anterior cerebral artery dissection presenting recurrent transient ischemic attack.
A 37-year-old male suffered from right hemiparesis and aphasia. On admission, CT scans revealed no lesion. However, in the left carotid angiography, an irregularity of the wall was observed at the left A2 proximal portion. The symptoms disappeared after about 4 hours. Under conservative treatment, the symptoms appeared intermittently. Since the progress of the dissection of the left callosomarginal artery was observed in the cerebral angiography, we performed an emergency operation. We performed side-to-side anastomoses on the left obstructed pericallosal artery and the left callosomarginal artery whose dissection had progressed to the other side. Furthermore, we ligated the left A2 proximal portion, which had expanded with a dark red color. The postoperative course was uneventful. Ischemic attack was not observed.
We believe that an arterial progressive dissection with ischemic symptoms requires surgical treatment.
