Minim Invasive Neurosurg 2003; 46(6): 357-360
DOI: 10.1055/s-2003-812503
Case Report
© Georg Thieme Verlag Stuttgart · New York

Spontaneous Dissecting Aneurysm of Middle Cerebral Artery: A Case Report with Review of the Literature

L.  Ning1 , Y.  Kato1 , H.  Sano1 , R.  B. R.  Nair1 , M.  Yoneda1 , S.  Watanabe1 , T.  Kanno1
  • 1Department of Neurosurgery, Fujita Health University, Aichi, Japan
Further Information

Publication History

Publication Date:
17 February 2004 (online)

Abstract

We report a case of a dissecting aneurysm of the middle cerebral artery (MCA) and its treatment strategies. A 50-year-old male patient presented with occipital and neck pain for 2 days. CT scan revealed subarachnoid hemorrhage (SAH) in the region of the right sylvian fissure. A left carotid angiogram showed a dissecting aneurysm of the left MCA (M1). He was treated surgically by a pterional trans-sylvian approach. Clipping was done along with additional reinforcement by wrapping to completely obliterate the neck of the aneurysm. On reviewing the literature, we think that dissecting aneurysms seem to be one of the important causes of SAH and cerebral infarction of unverified origin. If an MCA dissecting aneurysm is identified, especially located in the proximal portion, surgical treatment must be considered. These patients merit a close follow-up.

References

  • 1 Berger M S, Wilson C B. Intracranial dissecting aneurysm of the posterior circulation. Report of six cases and review of literature.  J Neurosurg. 1984;  61 882-894
  • 2 Hegedus K. Reticular fiber deficiency in the intracranial arteries of patients with dissecting aneurysm and review of the possible pathogenesis of previously reported cases.  Eur Arch Psychiatr Neurol Sci. 1985;  235 102-106
  • 3 Lanzino G, Kaptain G, Kellues D. Intracranial dissecting aneurysm causing subarachnoid hemorrhage: the role of computed tomographic angiography and magnetic resonance angiography.  Surg Neurol. 1997;  48 477-481
  • 4 Abiko S, Okamura T, Kurokawa Y. Diagnosis and treatment of nontraumatic dissecting aneurysm in the middle cerebral artery.  No Shinkei Geka. 1999;  27 743-749
  • 5 Anzai K, Sasaki T, Nakagawa J. Three dissecting aneurysms of the middle cerebral artery with subarachnoid hemorrhage.  Surg Cereb Stroke (Jpn). 1999;  27 198-202
  • 6 Fu Y, Komiyama M, Inoue T. A case of middle cerebral artery occlusion caused by dissecting aneurysm.  No Shinkei Geka. 1996;  24 955-959
  • 7 Gherardi G J, Lee H Y. Localized dissecting hemorrhage and arteritis.  JAMA. 1967;  199 187-189
  • 8 Grosman H, Fornasier V L, Bonder D. Dissecting aneurysm of the cerebral arteries. Case report.  J Neurosurg. 1980;  53 693-697
  • 9 Hashimoto N, Suzuki O, Takakubo Y. et al . A dissecting aneurysm of the middle cerebral artery. A case report.  Jpn J Neurosurg (Tokyo). 1995;  4 281-286
  • 10 Hashimoto H, Iida J, Shin Y. Subarachonid hemorrhage from intracranial dissecting aneurysms of the anterior circulation. Two case reports.  Neurol Med Chir (Tokyo). 1999;  39 442-446
  • 11 Kamiyama H, Nomura M, Abe H. Diagnosis for the intracranial dissecting aneurysms.  Surg Cereb Stroke (Jpn). 1990;  18 50-56
  • 12 Kawaguchi T, Kawano T, Kazekawa K. Dissecting aneuryms of the middle cerebral artery with subarachnoid hemorrhage and brain infarction: a case report.  No Shinkei Geka. 1997;  25 1033-1037
  • 13 Kitani R, Itouji T, Noda Y. Dissecting aneurysms of the anterior circle of Willis arteries: report of two cases.  J Neurosurg. 1987;  67 296-300
  • 14 Kunze S T, Schiefer W. Angiographic demonstration of a dissecting aneuryms of the middle cerebral artery.  Neuroradiology. 1971;  2 201-206
  • 15 Mizutani T, Goldberg H I, Parr J. Cerebral dissecting aneurysm and intimal fibroelastic thickening of cerebral arteries. Case report.  J Neurosurg. 1982;  56 571-576
  • 16 Mizutani T. Middle cerebral artery dissecting aneurysm with persistent patent pseudolumen. Case report.  J Neurosurg. 1996;  84 267-268
  • 17 Nimura T, Oku T, Narita N. Dissecting aneurysm of the middle cerebral artery: case report.  No Shinkei Geka. 2000;  28 61-65
  • 18 Otawara Y, Suzuki M, Abe M. Dissecting aneurysms of the anterior cerebral artery and accessory middle cerebral artery. Case report.  Neurosurg Rev. 1997;  20 145-148
  • 19 Piepgras D G, McGrail K M, Tazelaar H D. Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm. Case report.  J Neurosurg. 1994;  80 909-913
  • 20 Sasaki O, Koike T, Tanaka R. Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report.  J Neurosurg. 1991;  74 504-507
  • 21 Sato O, Bascom J F, Logothetis J. Intracranial dissecting aneurysm. Case report.  J Neurosurg. 1971;  35 483-487
  • 22 Sharif A A, Remley K B, Clark H B. Middle cerebral artery dissection: a clinicopathologic study.  Neurology. 1995;  45 1929-1931
  • 23 Yonas H, Agamanolis D, Takaoka Y. Dissecting intracranial aneurysms.  Surg Neurol. 1977;  8 407-415
  • 24 Masahito K, Susumu Y, Yukitaka U. Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction.  Surg Neurol. 2002;  57 428-436
  • 25 Mitsuo I, Tatsuya A, Makoto G. Middle cerebral artery dissecting aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset.  Surg Neurol. 2002;  57 346-349
  • 26 Ikeda T, Kurita H, Konishi Y. et al . De novo dissecting aneurysm in a patient with a ruptured saccular lesion.  J Neurosurg. 2002;  97 701-704
  • 27 Ono Y, Kawamura T, Ito J. Dissecting aneurysm of the middle cerebral artery (M1 - 2 portion) with subarachnoid hemorrhage.  No Shinkei Geka. 2001;  29 347-352
  • 28 Chaves C, Estol C, Esnaola M M. Spontaneous intracranial internal carotid artery dissection: case report of 10 patients.  Arch Neurol. 2002;  59 977-981
  • 29 Niikawa S, Yamada J, Sumi Y. Dissecting aneurysm of the MCA manifesting as subarachnoid hemorrhage and hemorrhagic infarction.  Neurol Med Chir. 2002;  42 62-66
  • 30 Nakatomi H, Nagata K, Kawamoto S. Ruptured dissecting aneurysm as a cause of subarachnoid hemorrhage of unverified etiology.  Stroke. 1997;  28 1278-1282
  • 31 Mori K, Yamamoto T, Maeda M. Dissecting aneurysm confined to the anterior cerebral artery.  J Neurosurg. 2002;  16 158-164

Yoko Kato, M. D. 

Department of Neurosurgery · Fujita Health University

Toyoake

Aichi 470-1192

Japan

Email: neuron@fujita-hu.ac.jp