title: Neuroradiologic and clinical features of arterial dissection of the anterior cerebral artery.
abstract: OBJECTIVE
  Case reports of nontraumatic arterial dissection of the anterior cerebral artery (ACA) have recently increased. The aim of this study was to investigate the neuroradiologic and clinical features of ACA dissection based on a series of collected cases.
  
  
  METHODS
  The cases of 18 patients with a diagnosis of ACA dissection based on clinical signs and neuroradiologic findings from 46 stroke centers during a 5-year period were collected. The neuroradiologic and clinical records were analyzed.
  
  
  RESULTS
  The mean patient age was 52.8 +/- 9.8 years. Five cases presented with subarachnoid hemorrhage, nine with cerebral ischemia, and four with both ischemic symptoms and subarachnoid hemorrhage. In cases presenting with ischemia, the main site of the lesion was the A2 portion and the main angiographic finding was stenosis with or without dilation. Follow-up angiography showed progression of the stenosis in the acute stage and resolution of the stenosis in the chronic stage. Hyperintensity around the flow void due to intramural hematoma on T1-weighted MR images was often seen during the second week. In all cases, the findings of MR angiography corresponded to the findings of cerebral angiography. Eight of nine cases showed a good prognosis. In three of the patients with bleeding, in whom the site of the lesion was at the A1 portion, a diffuse thick subarachnoid hemorrhage was present and surgical treatment was required but resulted in a poor prognosis. In the other patients with bleeding, in whom the site of the lesion was at the distal ACA, the prognosis was good and no rebleeding or need for surgical treatment occurred.
  
  
  CONCLUSIONS
  ACA dissection presenting with ischemia has several identifiable neuroradiologic and clinical characteristics, which suggests that it may be classified as a unique clinical entity.
authors.affiliation: Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ohkuma
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Suzuki
authors.forename: Tomoshige
authors.initials: T
authors.lastname: Kikkawa
authors.forename: Norihito
authors.initials: N
authors.lastname: Shimamura
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000175:diagnosis*; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000175:diagnosis; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000145:classification / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012039:Regional Blood Flow / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000145:classification / Q000175:diagnosis; D014057:Tomography, X-Ray Computed