title: [Vertebrobasilar artery dissection with subarachnoid hemorrhage after brain stem infarct showing an improvement on angiography: case report].
abstract: A 66-year-old male presented with dysarthria and right hemiparesis. Cerebral angiography at onset showed obliteration of the basilar artery and dilatation in the left vertebral artery. The patient's clinical symptoms were exaggerated and he was finally diagnosed to as suffering locked-in syndrome. Magnetic resonance imaging showed a brain stem infarction from the pons to the left middle cerebellar peduncle. We determined that the patient suffered dissection of the left vertebral artery at the basilar artery and treated, using the conservative therapy him of strict blood pressure control. A second angiography 13 days after onset showed recanalization of the basilar artery. At 29 days after onset, the patient fell into a coma with subarachnoid hemorrhage and acute hydrocephalus. Cerebral angiography revealed improvement in the irregularity and dilatation of the basilar artery, but the point of rupture could not be clearly identified. After performing proximal occlusion of the left vertebral artery by intravascular surgery, both right STA-SCA anastomosis and proximal occlusion of the right vertebral artery were carried out. Unfortunately, the patient died. Based on there data, it is appointed out that patients with a dissection of the vertebrobasilar artery must be followed up by serial angiography, and even if an angiographical improvement of the dissection is observed, the risk of subarachnoid hemorrhage still exists in patients suffering ischemic stroke.
authors.affiliation: Department of Neurosurgery, Showa General Hospital, 2-450, Tenjin-cho, Kodaira-city, Tokyo 187-0004, Japan.
authors.forename: Gakushi
authors.initials: G
authors.lastname: Yoshikawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kawamoto
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ono
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yakou
authors.forename: Munehisa
authors.initials: M
authors.lastname: Shinozaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsutsumi
mesh_terms: D000368:Aged; D020526:Brain Stem Infarctions / Q000150:complications*; D002533:Cerebral Angiography; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000000981:diagnostic imaging