Benign arterial dissections of the posterior circulation.
Four young adults with spontaneous dissection of the vertebrobasilar system are reported. Clinically, two patients presented with subarachnoid hemorrhage and two with brain-stem ischemia. In two cases of ruptured arterial dissection of the posterior cerebral artery, angiography demonstrated fusiform and "sausage-like" dilatation of the involved vessel. In two cases of occlusive dissection of the basilar artery, angiography revealed the typical "string sign." All four patients were treated conservatively: three survive in good clinical condition and one remains disabled. Follow-up angiograms showed spontaneous healing of the lesion with return to an almost normal arterial configuration in two cases; residual narrowing corresponding to the dissection was the most notable finding in the other two. It is recommended that, in a subset of neurologically stable patients, angiographic monitoring is undertaken to assess the tendency for spontaneous repair before surgical intervention is planned.
Pozzati
E
E
Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
Padovani
R
R
Fabrizi
A
A
Sabattini
L
L
Gaist
G
G
D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D001488:Basilar Artery / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D008297:Male; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014711:Vertebral Artery / Q000000981:diagnostic imaging