Middle cerebral artery dissecting aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset: a case report.
BACKGROUND
We report a case of dissecting middle cerebral artery (MCA) aneurysm causing intracerebral hemorrhage 4 years after the non-hemorrhagic onset.


METHODS
A 30-year-old male was diagnosed with an unruptured dissecting MCA aneurysm after a severe pulsating headache in August 1993. Angiography revealed dilatation of the distal portion of the temporo-occipital artery. During 2 years of follow-up, there were no significant changes on magnetic resonance imaging. In August 1997, he became comatose because of massive intracerebral hemorrhage caused by a dilated fusiform dissecting aneurysm. Emergency surgery and postoperative mild hypothermia resulted in full recovery.


CONCLUSIONS
To date only 30 cases of dissecting MCA aneurysm have been reported and for unruptured aneurysms, surgical intervention was not chosen. However, the present case strongly suggests that long-term follow-up is necessary in patients with unruptured dissecting aneurysms of the anterior circulation, especially those with ectatic components.
Department of Neurosurgery, Oita Medical University, Oita, Japan.
Mitsuo
M
Isono
Tatsuya
T
Abe
Makoto
M
Goda
Keisuke
K
Ishii
Hidenori
H
Kobayashi
D000328:Adult; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed