title: Subarachnoid hemorrhage after an ischemic attack due to a bacterial middle cerebral artery dissecting aneurysm: case report and literature review.
abstract: A 78-year-old woman suffered sudden-onset left hemiparesis. There were no remarkable infectious findings. Computed tomography (CT) demonstrated a low-intensity area supplied by the right middle cerebral artery (MCA). The diagnosis was cerebral ischemia and she was conservatively treated with hyperosmotic fluids. Two days after the ischemic stroke she suddenly became comatose. CT showed diffuse subarachnoid hemorrhage (SAH) in the basal cistern associated with a right intra-Sylvian and a right frontal subcortical hematoma. Three-dimensional (3D)-CT angiography demonstrated occlusion of the M2 portion of the right MCA. Four days after the ischemic onset she died of brain herniation. Autopsy revealed arterial dissection in the intermediate membrane of the right MCA bifurcation and occlusion of the M2 portion of the thrombosed right MCA. Gram staining showed remarkable bacterial infection in the thrombus. SAH after an ischemic attack due to MCA dissection is extremely rare. We suspect that bacterial infection was involved in the formation of her fragile dissecting aneurysm.
authors.affiliation: Department of Neurosurgery, Aomori Prefectural Central Hospital.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Emiko
authors.initials: E
authors.lastname: Hori
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanamori
authors.forename: Shinjitsu
authors.initials: S
authors.lastname: Nishimura
authors.forename: Seiya
authors.initials: S
authors.lastname: Sannohe
authors.forename: Mitsuomi
authors.initials: M
authors.lastname: Kaimori
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sasaki
authors.forename: Michiharu
authors.initials: M
authors.lastname: Nishijima
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging; D000785:Aneurysm, Infected / Q000150:complications* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology*; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed