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: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors: Ajit S
authors: AS
authors: Puri
authors: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors: Matthew J
authors: MJ
authors: Gounis
authors: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors: Francesco
authors: F
authors: Massari
authors: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors: Mary
authors: M
authors: Howk
authors: Department of Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
authors: John
authors: J
authors: Weaver
authors: Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
authors: Ajay K
authors: AK
authors: Wakhloo
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
keywords: Aneurysm; Dissection; Intervention; Stent; Subarachnoid