title: Dissecting posterior inferior cerebellar artery aneurysm presenting with subarachnoid hemorrhage right after anticoagulant and antiplatelet therapy against ischemic event.
abstract: BACKGROUND
  Dissecting aneurysms with initial ischemic manifestations may present with subsequent subarachnoid hemorrhage (SAH), and their treatment is controversial. This is a case report that illustrates the dilemma when dealing with an immediate post-SAH period dissecting posterior inferior cerebellar artery (PICA) aneurysm initially presenting with an ischemic event.
  
  
  METHODS
  We present a 57-year-old man with a dissecting PICA aneurysm who had SAH right after anticoagulant and antiplatelet therapy for cerebral infarction. The aneurysm was not detected by magnetic resonance angiography performed at the time of admission.
  
  
  RESULTS
  On admission, he was treated with both anticoagulant and antiplatelet therapy. After the SAH episode, he underwent emergent resection of the dissecting aneurysm and left OA-PICA anastomosis.
  
  
  CONCLUSIONS
  If hemorrhagic transformation occurs at the site of an ischemic dissecting aneurysm, surgical or endovascular intervention should be considered immediately. Although the optimal treatment of dissecting aneurysms with ischemic onset remains controversial, anticoagulant and antiplatelet therapy should not be rejected out of hand.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Chiba Hokuso Hospital, Nippon Medical School, Chiba 270-1694, Japan. takumi@nms.ac.jp
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takumi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mizunari
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mishina
authors.forename: Takaharu
authors.initials: T
authors.lastname: Fukuchi
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Nomura
authors.forename: Katsuya
authors.initials: K
authors.lastname: Umeoka
authors.forename: Shiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001158:Arteries; D002545:Brain Ischemia / Q000517:prevention & control; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors