title: [Case of spontaneous bilateral VA dissecting aneurysm presenting with SAH].
abstract: We report a case of bilateral vertebral artery (VA) dissecting aneurysm presenting subarachnoid hemorrhage (SAH). It was difficult to decide which side was responsible for SAH because the patient's symptom and head CT suggested that the left VA aneurysm had ruptured, but angiography and MRA showed an irregular pearl and string sign on the right side. He was successfully treated by trapping of the right VA dissecting aneurysm and we confirmed by intraoperative evaluation that the right VA dissecting aneurysm had ruptured. The left unruptured aneurysm decreased its size spontaneously. In the treatment of the bilateral VA dissecting aneurysms, angiography needs to be performed over and over again because contralateral unruptured aneurysm may grow or rupture due to increased hemodynamic stress. Various combinations of direct sugery with or without arterial reconstruction and endovascular treatment should be considered when treating bilateral VA dissecting aneurysms.
authors.affiliation: Department of Neurosurgery, Nagoya University, 65 Tsurumai, Showa-ku, Nagoya 466-8560, Japan.
authors.forename: Yusuke A
authors.initials: YA
authors.lastname: Nishimu
authors.forename: Akira
authors.initials: A
authors.lastname: Ikeda
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Sugita
authors.forename: Kenkou
authors.initials: K
authors.lastname: Maeda
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Nakamua
authors.forename: Masaya
authors.initials: M
authors.lastname: Takerroto
authors.forename: Masato
authors.initials: M
authors.lastname: Shibuya
mesh_terms: D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000601:surgery