title: Fatal bleeding from arterial dissection after clipping of a ruptured aneurysm--case report.
abstract: A 67-year-old man died of subarachnoid hemorrhage (SAH) resulting from dissection of the distal part of the anterior cerebral artery (ACA). A saccular aneurysm in the anterior communicating artery had ruptured and was successfully clipped on Day 0. The patient recovered consciousness after surgery but his condition deteriorated due to another SAH on Day 1. A second surgical procedure disclosed bleeding from a laceration in the opposite wall of the ACA distal to the clipped aneurysm. Histological examination of the autopsy specimens revealed damage to the internal elastic lamina and inflammatory infiltration of leukocytes. The fatal dissection may have resulted from atherosclerosis, hemodynamic stress caused by hypertension, or trauma due to surgical manipulation.
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama.
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Goto
authors.forename: Masato
authors.initials: M
authors.lastname: Hojo
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Kikuta
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D017809:Fatal Outcome; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed