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Dissecting posterior inferior cerebellar artery aneurysm presenting with subarachnoid hemorrhage right after anticoagulant and antiplatelet therapy against ischemic event.
Surg Neurol. 2007 Jul; 68(1):103-7; discussion 107.SN

Abstract

BACKGROUND

Dissecting aneurysms with initial ischemic manifestations may present with subsequent subarachnoid hemorrhage (SAH), and their treatment is controversial. This is a case report that illustrates the dilemma when dealing with an immediate post-SAH period dissecting posterior inferior cerebellar artery (PICA) aneurysm initially presenting with an ischemic event.

METHODS

We present a 57-year-old man with a dissecting PICA aneurysm who had SAH right after anticoagulant and antiplatelet therapy for cerebral infarction. The aneurysm was not detected by magnetic resonance angiography performed at the time of admission.

RESULTS

On admission, he was treated with both anticoagulant and antiplatelet therapy. After the SAH episode, he underwent emergent resection of the dissecting aneurysm and left OA-PICA anastomosis.

CONCLUSION

If hemorrhagic transformation occurs at the site of an ischemic dissecting aneurysm, surgical or endovascular intervention should be considered immediately. Although the optimal treatment of dissecting aneurysms with ischemic onset remains controversial, anticoagulant and antiplatelet therapy should not be rejected out of hand.

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Authors+Show Affiliations

Takumi I
Department of Neurosurgery, Neurological Institute, Chiba Hokuso Hospital, Nippon Medical School, Chiba 270-1694, Japan. takumi@nms.ac.jp
Mizunari T
No affiliation info available
Mishina M
No affiliation info available
Fukuchi T
No affiliation info available
Nomura R
No affiliation info available
Umeoka K
No affiliation info available
Kobayashi S
No affiliation info available
Teramoto A
No affiliation info available

MeSH

Aneurysm, DissectingAngiography, Digital SubtractionAnticoagulantsArteriesBrain IschemiaCerebellumCerebral AngiographyCerebral InfarctionHumansIntracranial AneurysmMagnetic Resonance ImagingMaleMiddle AgedNeurosurgical ProceduresPlatelet Aggregation InhibitorsSubarachnoid HemorrhageTomography, X-Ray Computed

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17586241

Citation

Takumi, Ichiro, et al. "Dissecting Posterior Inferior Cerebellar Artery Aneurysm Presenting With Subarachnoid Hemorrhage Right After Anticoagulant and Antiplatelet Therapy Against Ischemic Event." Surgical Neurology, vol. 68, no. 1, 2007, pp. 103-7; discussion 107.
Takumi I, Mizunari T, Mishina M, et al. Dissecting posterior inferior cerebellar artery aneurysm presenting with subarachnoid hemorrhage right after anticoagulant and antiplatelet therapy against ischemic event. Surg Neurol. 2007;68(1):103-7; discussion 107.
Takumi, I., Mizunari, T., Mishina, M., Fukuchi, T., Nomura, R., Umeoka, K., Kobayashi, S., & Teramoto, A. (2007). Dissecting posterior inferior cerebellar artery aneurysm presenting with subarachnoid hemorrhage right after anticoagulant and antiplatelet therapy against ischemic event. Surgical Neurology, 68(1), 103-7; discussion 107.
Takumi I, et al. Dissecting Posterior Inferior Cerebellar Artery Aneurysm Presenting With Subarachnoid Hemorrhage Right After Anticoagulant and Antiplatelet Therapy Against Ischemic Event. Surg Neurol. 2007;68(1):103-7; discussion 107. PubMed PMID: 17586241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dissecting posterior inferior cerebellar artery aneurysm presenting with subarachnoid hemorrhage right after anticoagulant and antiplatelet therapy against ischemic event. AU - Takumi,Ichiro, AU - Mizunari,Takayuki, AU - Mishina,Masahiro, AU - Fukuchi,Takaharu, AU - Nomura,Ryutaro, AU - Umeoka,Katsuya, AU - Kobayashi,Shiro, AU - Teramoto,Akira, PY - 2005/10/12/received PY - 2006/08/21/accepted PY - 2007/6/26/pubmed PY - 2007/8/22/medline PY - 2007/6/26/entrez SP - 103-7; discussion 107 JF - Surgical neurology JO - Surg Neurol VL - 68 IS - 1 N2 - BACKGROUND: Dissecting aneurysms with initial ischemic manifestations may present with subsequent subarachnoid hemorrhage (SAH), and their treatment is controversial. This is a case report that illustrates the dilemma when dealing with an immediate post-SAH period dissecting posterior inferior cerebellar artery (PICA) aneurysm initially presenting with an ischemic event. METHODS: We present a 57-year-old man with a dissecting PICA aneurysm who had SAH right after anticoagulant and antiplatelet therapy for cerebral infarction. The aneurysm was not detected by magnetic resonance angiography performed at the time of admission. RESULTS: On admission, he was treated with both anticoagulant and antiplatelet therapy. After the SAH episode, he underwent emergent resection of the dissecting aneurysm and left OA-PICA anastomosis. CONCLUSION: If hemorrhagic transformation occurs at the site of an ischemic dissecting aneurysm, surgical or endovascular intervention should be considered immediately. Although the optimal treatment of dissecting aneurysms with ischemic onset remains controversial, anticoagulant and antiplatelet therapy should not be rejected out of hand. SN - 0090-3019 UR - https://www.unboundmedicine.com/medline/citation/17586241/Dissecting_posterior_inferior_cerebellar_artery_aneurysm_presenting_with_subarachnoid_hemorrhage_right_after_anticoagulant_and_antiplatelet_therapy_against_ischemic_event_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-3019(06)00795-6 DB - PRIME DP - Unbound Medicine ER -