title: Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection.
abstract: Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up.
authors.affiliation: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Howk
authors.affiliation: Department of Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
authors.forename: John
authors.initials: J
authors.lastname: Weaver
authors.affiliation: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Wakhloo
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D006261:Headache / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D013575:Syncope / Q000209:etiology; D016896:Treatment Outcome
keywords: Aneurysm; Dissection; Intervention; Stent; Subarachnoid
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