Subarachnoid Hemorrhage in the Presence of Both Intracranial Dissecting and Saccular Aneurysms-Two Case Reports
| Autor: | Kouzo Moritake, Yasuhiko Akiyama, Takeshi Miyazaki, Hidemasa Nagai |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage Cerebral infarction business.industry Vertebral artery medicine.disease Asymptomatic nervous system diseases Surgery Dissection Cerebral vasospasm Aneurysm medicine.artery cardiovascular system medicine cardiovascular diseases Neurology (clinical) Radiology medicine.symptom business Stroke |
| Zdroj: | Neurologia medico-chirurgica. 47:65-69 |
| ISSN: | 1349-8029 0470-8105 |
| DOI: | 10.2176/nmc.47.65 |
| Popis: | Two patients presented with subarachnoid hemorrhage (SAH) associated with both intracranial dissecting and saccular aneurysms. Case 1, a 48-year-old woman, had a saccular aneurysm of the right internal carotid artery and dissecting aneurysms of the bilateral vertebral arteries. Case 2, a 52-year-old man, had three saccular aneurysms in the anterior circulation and a dissecting aneurysm of the unilateral vertebral artery. A saccular aneurysm was responsible for the SAH in both patients. Ruptured saccular aneurysms were treated with surgical clipping and unruptured dissecting aneurysms remained untreated. SAH recurred due to bleeding from an untreated dissecting aneurysm 4 days after the initial SAH in Case 1. Triple-H therapy, which causes increased hemodynamic stress, was not administered for symptomatic cerebral vasospasm after SAH in Case 2, because of the risk of bleeding from the untreated dissecting aneurysm, and the patient suffered cerebral infarction. The risk factors for this rare association are unclear, but both patients were smokers and had hypocholesterolemia including low apolipoprotein E levels. The clinical management of patients with SAH and both dissection and saccular aneurysms is complicated. Asymptomatic dissecting aneurysm has a benign clinical course in general, but hemodynamic stress related to stroke may induce abrupt development of dissecting aneurysms. Prophylactic obliteration during the acute stage of SAH may provide better outcomes if the unruptured dissecting lesion appears as obvious aneurysmal dilatation or pearl-and-string sign and is safely treatable with endovascular trapping. |
| Databáze: | OpenAIRE |
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