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[Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage undetectable on preoperative neuroradiological findings: case report].
No To Shinkei. 2004 Nov; 56(11):965-70.NT

Abstract

We report a rare case of a dissecting aneurysm (DA) of the middle cerebral artery(MCA) associated with subarachnoid hemorrhage(SAH) undetectable on preoperative neuroradiological findings. A 64-year-old man was admitted to our hospital because of a sudden onset of occipital headache. CT scan showed SAH mainly in the basal cisterns and left sylvian fissure. Three-dimensional CT angiograms revealed a saccular aneurysmal protuberance at the left internal carotid-posterior communicating artery (IC-PC) region, whereas no abnormal findings at the M2 inferior trunk of the left MCA. Left internal carotid angiograms showed a saccular aneurysmal protuberance at the ICPC region. So, preoperative diagnosis of a ruptured left IC-PC aneurysm was based on the above neuroradiological findings. The patient was surgically treated through the left pterional transsylvian approach. No aneurysm was observed either at the left IC-PC region or the trifurcation of the left MCA. The posterior communicating artery had severe arteriosclerotic change was observed. Aneurysmal dilatation with a dark-purplish & reddish wall was detected at the M2 inferior trunk of the left MCA, which was thought to be the cause of the current SAH. To prevent bleeding, the lesion was clipped on wrapping with Bemsheets. Left internal carotid angiograms obtained 40 days after the onset revealed no occlusive findings at the M2 inferior trunk of the MCA was clipped on wrapping with Bemsheets. Retrospectively, preoperative angiograms revealed severe stenosis at the M2 inferior trunk of the MCA. The postoperative course was uneventful and the patient was discharged without neurological deficits. There has been no rebleeding nor new ischemic attack during the ten months since surgery. The 20 reported cases of a DA of the MCA associated with SAH with our case are reviewed and their neuroradiological and clinical features are discussed.

Authors+Show Affiliations

Shioya H
Department of Neurosurgery, Yuri Kumiai General Hospital, 38 Kawaguchi-aza-yago, Honjo-shi, Akita 015-8511, Japan.
Kikuchi K
No affiliation info available
Suda Y
No affiliation info available
Shoji H
No affiliation info available
Shindo K
No affiliation info available

MeSH

Aortic DissectionAneurysm, RupturedCerebral AngiographyHumansImaging, Three-DimensionalIntracranial AneurysmMaleMiddle AgedMiddle Cerebral ArterySubarachnoid HemorrhageTomography, X-Ray Computed

Pub Type(s)

Case Reports
Journal Article
Review

Language

jpn

PubMed ID

15678955

Citation

Shioya, Hitoshi, et al. "[Dissecting Aneurysm of the Middle Cerebral Artery With Subarachnoid Hemorrhage Undetectable On Preoperative Neuroradiological Findings: Case Report]." No to Shinkei = Brain and Nerve, vol. 56, no. 11, 2004, pp. 965-70.
Shioya H, Kikuchi K, Suda Y, et al. [Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage undetectable on preoperative neuroradiological findings: case report]. No To Shinkei. 2004;56(11):965-70.
Shioya, H., Kikuchi, K., Suda, Y., Shoji, H., & Shindo, K. (2004). [Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage undetectable on preoperative neuroradiological findings: case report]. No to Shinkei = Brain and Nerve, 56(11), 965-70.
Shioya H, et al. [Dissecting Aneurysm of the Middle Cerebral Artery With Subarachnoid Hemorrhage Undetectable On Preoperative Neuroradiological Findings: Case Report]. No To Shinkei. 2004;56(11):965-70. PubMed PMID: 15678955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage undetectable on preoperative neuroradiological findings: case report]. AU - Shioya,Hitoshi, AU - Kikuchi,Kenji, AU - Suda,Yoshitaka, AU - Shoji,Hidehiko, AU - Shindo,Kenjiro, PY - 2005/2/1/pubmed PY - 2005/2/8/medline PY - 2005/2/1/entrez SP - 965 EP - 70 JF - No to shinkei = Brain and nerve JO - No To Shinkei VL - 56 IS - 11 N2 - We report a rare case of a dissecting aneurysm (DA) of the middle cerebral artery(MCA) associated with subarachnoid hemorrhage(SAH) undetectable on preoperative neuroradiological findings. A 64-year-old man was admitted to our hospital because of a sudden onset of occipital headache. CT scan showed SAH mainly in the basal cisterns and left sylvian fissure. Three-dimensional CT angiograms revealed a saccular aneurysmal protuberance at the left internal carotid-posterior communicating artery (IC-PC) region, whereas no abnormal findings at the M2 inferior trunk of the left MCA. Left internal carotid angiograms showed a saccular aneurysmal protuberance at the ICPC region. So, preoperative diagnosis of a ruptured left IC-PC aneurysm was based on the above neuroradiological findings. The patient was surgically treated through the left pterional transsylvian approach. No aneurysm was observed either at the left IC-PC region or the trifurcation of the left MCA. The posterior communicating artery had severe arteriosclerotic change was observed. Aneurysmal dilatation with a dark-purplish & reddish wall was detected at the M2 inferior trunk of the left MCA, which was thought to be the cause of the current SAH. To prevent bleeding, the lesion was clipped on wrapping with Bemsheets. Left internal carotid angiograms obtained 40 days after the onset revealed no occlusive findings at the M2 inferior trunk of the MCA was clipped on wrapping with Bemsheets. Retrospectively, preoperative angiograms revealed severe stenosis at the M2 inferior trunk of the MCA. The postoperative course was uneventful and the patient was discharged without neurological deficits. There has been no rebleeding nor new ischemic attack during the ten months since surgery. The 20 reported cases of a DA of the MCA associated with SAH with our case are reviewed and their neuroradiological and clinical features are discussed. SN - 0006-8969 UR - https://www.unboundmedicine.com/medline/citation/15678955/[Dissecting_aneurysm_of_the_middle_cerebral_artery_with_subarachnoid_hemorrhage_undetectable_on_preoperative_neuroradiological_findings:_case_report]_ DB - PRIME DP - Unbound Medicine ER -