title: [Anterior Communicating Artery Dissection Presenting with Subarachnoid Hemorrhage and Cerebral Infarction].
abstract: We describe the case of subarachnoid hemorrhage and cerebral infarction that developed simultaneously and was caused by suspected dissection of the anterior communicating artery. A 65-year-old woman presented with sudden onset of headache and nausea. Head computed tomography(CT)and magnetic resonance imaging revealed subarachnoid hemorrhage in the interhemispheric fissure and a spotty ischemic lesion in the right frontal cortex. Both, CT angiography and angiography with arterial catheterization showed an aneurysmal dilatation of the anterior communicating artery. A repeated CT angiography nine days later demonstrated enlargement of the aneurysmal dilatation. The patient underwent craniotomy under general anesthesia. Under the microscope, a thick hematoma was seen infero-dorsally from the anterior communicating artery. Two fenestrations of the anterior communicating artery were identified. After removal of the hematoma, a fusiform dilatation of the anterior communicating artery with a firm and reddish wall was confirmed. The lesion was coated with a teflon sponge and fibrin glue. The patient's postoperative course was uneventful. A follow-up CT angiography two months after surgery revealed shrinkage of the lesion, when compared with preoperative images.
authors.affiliation: Department of Neurosurgery, Iwate Medical University.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ogasawara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Takahiro
authors.initials: T
authors.lastname: Koji
authors.forename: Yuiko
authors.initials: Y
authors.lastname: Sato
authors.forename: Shunrou
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D000792:Angiography; D020771:Anterior Cerebral Artery; D002544:Cerebral Infarction / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014057:Tomography, X-Ray Computed