Good recovery of subarachnoid hemorrhage concomitant with ischemia due to anterior cerebral artery dissection by conservative treatment: A case report

Wang,Yiqi; Geng,Yu; Shi,Zongjie; Shi,Tianming; Zhang,Jinhua

doi:10.3892/etm.2017.4462

Good recovery of subarachnoid hemorrhage concomitant with ischemia due to anterior cerebral artery dissection by conservative treatment: A case report

Authors:
- Yiqi Wang
- Yu Geng
- Zongjie Shi
- Tianming Shi
- Jinhua Zhang
View Affiliations

Affiliations: Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
Published online on: May 17, 2017 https://doi.org/10.3892/etm.2017.4462
Pages: 155-158
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present report describes the case of a 57‑year‑old woman presenting with subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) due to anterior cerebral artery (ACA) dissection, which exhibited severe stenosis at the origin with distal dilatation of the A2 segment and occlusion of the A3 segment. In this case, computed tomography (CT) revealed SAH in right superior frontal sulcus and the interhemispheric fissure. Magnetic resonance imaging demonstrated acute infarct in the territory of the right ACA. Brain digital subtraction angiography showed severe stenosis at the origin of the A2 segment with distal dilatation and occlusion at the origin of the A3 segment of the right ACA, suggesting a diagnosis of dissection. Only treatment with atorvastatin, her clinical condition subsequently improved. The stenosis and dilatation of A2 segment were ameliorated as demonstrated by a follow‑up CT angiography 5 months after onset. SAH concomitant with ischemia caused by ACA dissection is rare. Conservative treatment may be a safe and effective choice for patients with SAH concomitant with AIS due to ACA dissection.

View Figures

View References

1	Kwak JH, Choi JW, Park HJ, Chae EY, Park ES, Lee DH and Suh DC: Cerebral artery dissection: Spectrum of clinical presentations related to angiographic findings. Neurointervention. 6:78–83. 2011. View Article : Google Scholar : PubMed/NCBI
2	Huang YC, Chen YF, Wang YH, Tu YK, Jeng JS and Liu HM: Cervicocranial arterial dissection: Experience of 73 patients in a single center. Surg Neurol. 72 Suppl 2:S20–S27. 2009. View Article : Google Scholar : PubMed/NCBI
3	Mizutani T: Natural course of intracranial arterial dissections. J Neurosurg. 114:1037–1044. 2011. View Article : Google Scholar : PubMed/NCBI
4	Ono H, Nakatomi H, Tsutsumi K, Inoue T, Teraoka A, Yoshimoto Y, Ide T, Kitanaka C, Ueki K, Imai H and Saito N: Symptomatic recurrence of intracranial arterial dissections: Follow-up study of 143 consecutive cases and pathological investigation. Stroke. 44:126–131. 2013. View Article : Google Scholar : PubMed/NCBI
5	Guridi J, Gállego J, Monzón F and Aguilera F: Intracerebral hemorrhage caused by transmural dissection of the anterior cerebral artery. Stroke. 24:1400–1402. 1993. View Article : Google Scholar : PubMed/NCBI
6	Ohkuma H, Suzuki S, Kikkawa T and Shimamura N: Neuroradiologic and clinical features of arterical dissection of the anterior cerebral artery. AJNR Am J Neuroradiol. 24:691–699. 2003.PubMed/NCBI
7	Suzuki I, Nishino A, Nishimura S, Numagami Y, Suzuki H, Utsunomiya A, Suzuki S, Uenohara H and Sakurai Y: Nontraumatic arterial dissection of the anterior cerebral artery: six cases report. No To Shinkei. 57:509–515. 2005.(In Japanese). PubMed/NCBI
8	Inoue T, Fujimura M, Mastsumoto Y, Kondo R, Inoue T, Shimizu H and Tominaga T: Simultaneous occurrence of subarachnoid hemorrhage and cerebral infarction caused by anterior cerebral artery dissection treated by endovascular trapping. Neurol Med Chir (Tokyo). 50:574–577. 2010. View Article : Google Scholar : PubMed/NCBI
9	Yasukama K, Kamijo Y, Momose G, Kobayashi S and Ikeda A: A case of anterior cerebral artery dissecting aneurysm presenting subarachnoid hemorrhage and cerebral infarction at the same time. Surg Cerebral Stroke. 21:461–466. 1993. View Article : Google Scholar
10	Kato N, Yamada Y, Hyodo A and Nose T: A case of anterior cerebral artery dissection presenting subarachnoid hemorrhage and cerebral infarction. No Shinkei Geka J. 9:157–161. 2000.(In Japanese).
11	Miyahara K, Sakata K, Gondo G, Kanno H and Yamamoto I: Spontaneous dissection of the anterior cerebral artery presenting subarachnoid hemorrhage and cerebral infarction: A case report. No Shinkei Geka. 29:335–339. 2001.(In Japanese). PubMed/NCBI
12	Kimura S, Igarashi T, Kotani A and Katayama Y: Nontraumatic arterial dissection of the anterior cerebral artery with simultaneous cerebral infarction and subarachnoid hemorrhage: A case report. No Shinkei Geka. 38:273–278. 2010.(In Japanese). PubMed/NCBI
13	Suzuki K, Mishina M, Okubo S, Abe A, Suda S, Ueda M and Katayama Y: Anterior cerebral artery dissection presenting subrarachnoid hemorrhage and cerebral infarction. J Nippon Med Sch. 79:153–158. 2012. View Article : Google Scholar : PubMed/NCBI
14	Nanbara S, Tsutsumi K, Takahata H, Fujimoto T, Kawahara I, Ono T, Toda K, Baba H and Yonekura M: Spontaneous dissection of the anterior cerebral artery that simultaneously presented with cerebral infarction and subarachnoid hemorrhage, successfully treated with conservative management: A case report. No Shinkei Geka. 40:635–642. 2012.(In Japanese). PubMed/NCBI
15	Im TS, Lee YS, Suh SJ, Lee JH, Ryu KY and Kang DG: Two cases of subarachnoid hemorrhage from spontaneous anterior cerebral artery dissection: A case of simultaneous hemorrhage and ischemia without aneurysmal formation and another case of hemorrhage with aneurysmal formation. J Cerebrovasc Endovasc Neurosurg. 16:119–124. 2014. View Article : Google Scholar : PubMed/NCBI
16	Kato Y, Hayashi T, Uchino A, Kakehi Y, Yamane F, Ishihara S and Tanahashi N: Fusiform dilatation of the outer contour of a dissected anterior cerebral artery revealed by magnetic resonance cisternography in a patient with simultaneous cerebral infarction and subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 23:1717–1720. 2014. View Article : Google Scholar : PubMed/NCBI
17	Han M, Rim NJ, Lee JS, Kim SY and Choi JW: Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection. Eur Radiol. 24:3017–3024. 2014. View Article : Google Scholar : PubMed/NCBI
18	Ahn SS, Kim BM, Suh SH, Kim DJ, Kim DI, Shin YS, Ha SY and Kwon YS: Spontaneous symptomatic intracranial vertebrobasilar dissection: Initial and follow-up imaging findings. Radiology. 264:196–202. 2012. View Article : Google Scholar : PubMed/NCBI
19	Nakajima M, Inatomi Y, Yonehara T, Hirano T and Ando Y: Nontraumatic convexal subarachnoid hemorrhage concomitant with acute ischemic stroke. J Stroke Cerebrovasc Dis. 23:1564–1570. 2014. View Article : Google Scholar : PubMed/NCBI
20	Singhal AB, Hajj-Ali RA, Topcuoglu MA, Fok J, Bena J, Yang D and Calabrese LH: Reversible cerebral vasoconstriction syndromes: Analysis of 139 cases. Arch Neurol. 68:1005–1012. 2011. View Article : Google Scholar : PubMed/NCBI
21	Kleinig TJ, Kimber TE and Thompson PD: Convexity subarachnoid haemorrhage associated with bilateral internal carotid artery stenosis. J Neurol. 256:669–671. 2009. View Article : Google Scholar : PubMed/NCBI
22	Debette S, Compter A, Labeyrie MA, Uyttenboogaart M, Metso TM, Majersik JJ, Goeggel-Simonetti B, Engelter ST, Pezzini A, Bijlenga P, et al: Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol. 14:640–654. 2015. View Article : Google Scholar : PubMed/NCBI
23	Geraldes R, Sousa PR, Fonseca AC, Falcão F, Canhão P and e Melo T Pinho: Nontraumatic convexity subarachnoid hemorrhage: Different etiologies and outcomes. J Stroke Cerebrovasc Dis. 13:e23–e30. 2014. View Article : Google Scholar