title: Spontaneous anterior cerebral artery dissection presenting with simultaneous subarachnoid hemorrhage and cerebral infarction in a patient with multiple extracranial arterial dissections.
abstract: Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subsequent stroke. In this setting, prompt treatment with stent-assisted endovascular embolization can be a reliable alternative to direct surgery. When multiple arterial dissections are coexistent, management strategy often became complicated. However, satisfactory clinical results can be obtained by acknowledging responsible arterial site with careful radiographic inspection and antiplatelet medication.
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Yung Ki
authors.initials: YK
authors.lastname: Park
authors.forename: Hyeong-Joong
authors.initials: HJ
authors.lastname: Yi
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Lee
authors.forename: Young-Seo
authors.initials: YS
authors.lastname: Kim
keywords: Anterior cerebral artery; Cerebral infarction; Dissecting aneurysm; Endovascular embolization; Subarachnoid hemorrhage
references.citation: Neurol Med Chir (Tokyo). 2010;50(7):574-7
references.pmid: 20671384
references.citation: AJNR Am J Neuroradiol. 2003 Apr;24(4):691-9
references.pmid: 12695205
references.citation: Surg Neurol. 1996 Jul;46(1):55-61
references.pmid: 8677490
references.citation: Surg Neurol. 2009 Dec;72 Suppl 2:S20-7; discussion S27
references.pmid: 19150115
references.citation: Surg Neurol. 1977 Dec;8(6):407-15
references.pmid: 594878
references.citation: J Nippon Med Sch. 2012;79(2):153-8
references.pmid: 22687360
references.citation: Can J Neurol Sci. 2008 May;35(2):146-52
references.pmid: 18574926
references.citation: J Neurosurg. 1994 Apr;80(4):667-74
references.pmid: 8151345
references.citation: Cerebrovasc Dis. 2010 Jan;29(2):170-7
references.pmid: 19955742
references.citation: Neurologist. 2008 Jan;14(1):5-6
references.pmid: 18195650
references.citation: Surg Neurol. 2002 Jun;57(6):428-36; discussion 436-8
references.pmid: 12176212
references.citation: J Neurosurg. 1999 Oct;91(4):682-6
references.pmid: 10507393