Anterior communicating artery aneurysm paraparesis syndrome: clinical manifestations and pathologic correlates.
OBJECTIVE
Clinicopathologic evaluation of patients with lower extremity paraparesis/-plegia following rupture and repair of anterior communicating artery (ACoA) aneurysms.


METHODS
Institution-based retrospective review.


METHODS
A tertiary neurologic referral center.


METHODS
Seven of 101 patients with subarachnoid hemorrhage from ruptured ACoA aneurysms treated between January 1987 and December 1992.


METHODS
Neurologic status at latest follow-up examination.


RESULTS
All patients presented with severe hemorrhage, poor clinical grade, and intracranial hypertension. Motor deficits developed within 7 days of aneurysm rupture and persisted for a mean duration of 39 days. Angiographic evidence of vasospasm in the anterior cerebral artery (ACA) distribution was documented in all cases, and paraparesis persisted beyond the angiographic resolution of vasospasm. All patients had evidence of frontal lobe dysfunction throughout their postoperative courses, and deep venous thrombosis and pulmonary emboli were common causes of morbidity and mortality. Autopsy data supported regional microvascular ischemia within the ACA distribution as the etiology of these motor deficits.


CONCLUSIONS
The combination of vasospasm in the ACA distribution and lower extremity weakness associated with cognitive and affective impairment that resolves with time is common in patients with ACoA aneurysms. We propose that this constellation of clinical, radiographic, and pathologic findings be referred to as the "ACoA aneurysm paraparesis syndrome."
Greene
K A
KA
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
Marciano
F F
FF
Dickman
C A
CA
Coons
S W
SW
Johnson
P C
PC
Bailes
J E
JE
Spetzler
R F
RF
D000368:Aged; D001344:Autopsy; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D009460:Neurologic Examination; D010243:Paralysis / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D011655:Pulmonary Embolism / Q000473:pathology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013927:Thrombosis / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome