Intracranial supraclinoid ICA dissection causing cerebral infarction and subsequent subarachnoid hemorrhage.
BACKGROUND
Intracranial arterial dissection usually leads to cerebral infarction or subarachnoid hemorrhage (SAH). It is rare to see both complications in one clinical scenario.


METHODS
Case report and review of the literature.


RESULTS
A 48-year-old woman suffered a left middle cerebral infarct from a dissection of the left supraclinoid ICA. As she was recovering from the ischemic stroke 5 days later she suffered a SAH. The SAH was caused by rupture of a dissecting pseudoaneurysm, which only became evident on repeat catheter angiography. The dissecting pseudoaneurysm was treated with coil occlusion.


CONCLUSIONS
Intracranial ICA dissections are typically associated with either ischemic or hemorrhagic presentation. We report an unusual case of a patient who suffered a SAH a few days after an ischemic stroke from the dissection. This case contradicts the long-held dogma that intracranial dissection can have either an ischemic or a hemorrhagic presentation, but not both.
Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Naif M
NM
Alotaibi
Jennifer E
JE
Fugate
Timothy J
TJ
Kaufmann
Alejandro A
AA
Rabinstein
Eelco F M
EF
Wijdicks
Giuseppe
G
Lanzino
D020215:Carotid Artery, Internal, Dissection / Q000150:complications* / Q000628:therapy; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome