[Serial angiographical changes of a ruptured dissecting vertebral aneurysm].
A 54-year-old woman presented a subarachnoid hemorrhage from a ruptured dissecting aneurysm on the right vertebral artery. A right vertebral angiogram revealed a fusiform dilatation distal to the right posterior inferior cerebellar artery and "pseudo lumen" was observed in a delayed arterial phase. Conservative treatment was carried out, and the patient condition gradually improved. An angiographical examination for planned endovascular treatment 46 days after the onset, revealed the normalization of the formerly dilated caliber of the right vertebral artery with only a minor luminal irregularity. However, 83 days after the onset, right vertebral angiogram showed reappearance of the fusiform dilatation. The right vertebral angiogram obtained 204 days after the onset showed that the dilated segment of the dissecting aneurysm had become normalized to a slight degree. The serial angiographical changes of the dissecting site might have been due to regression and organization following transient thrombosis of intramural hematoma. Such drastic changes within a short period have not been reported yet. In conclusion, careful repeated follow-up is recommended in monitoring aneurysmal formation during the early to chronic phase after rupture of a dissecting aneurysm. The repetition of angiography is important, because later, if angiography has been performed only once, aneurysmal dilatation may be overlooked. One has to be aware of such changes, because such changes may alter the clinician's decision about treatment, as they did in our case.
Nakai
Y
Y
Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Japan.
Yasuda
S
S
Matsumura
A
A
Matsumaru
Y
Y
Nose
T
T
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging* / Q000473:pathology