title: Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases.
abstract: BACKGROUND
  Spontaneous dissections of intracranial arteries are rare, but important causes of stroke, especially in younger patients. Dissections of the anterior cerebral artery (ACA) have been reported only very rarely in the European and North American populations but might be more prevalent than previously thought.
  
  
  METHODS
  This paper describes the presenting pattern of the disease, the clinical and imaging findings, as well as endovascular therapeutical options with respect to a meta-analysis of cases reported in the literature. Additionally, own observations in three recent representative cases are discussed.
  
  
  RESULTS
  Overall, 80 cases from recent literature were included to the meta-analysis. The median age was 51 (35-82) years. Ischemia alone was described in 58 cases (73 %), subarachnoid hemorrhage (SAH) in 8 cases (10 %), and a combination of both in 14 cases (17 %). Radiological diagnosis including use of thin-layered 3T-MRI vessel wall imaging with black blood technique was verified by double lumen, by a string sign or string and pearl sign, or by a vessel wall hematoma in 23 (32 %), 62 (89 %), and 14 (20 %) cases, respectively. Interventional or surgical treatment was performed in 7 cases. A good clinical recovery was achieved in 77 % of cases.
  
  
  CONCLUSIONS
  Dissections of the ACA mostly cause ischemia, but can cause SAH or a combination of both in a relatively young population. Detailed neuroradiological diagnosis including 3T-MRI vessel wall imaging is required as a double lumen, isolated stenosis due to vessel wall hematoma, or the secondary development of a pseudoaneurysm might occur. Interventional therapy is the primary therapy for these vascular complications.
authors: Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Arnold-Heller-Str.3, House 41, 24105, Kiel, Germany. johannes.hensler@uksh.de.
authors: Johannes
authors: J
authors: Hensler
authors: Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Arnold-Heller-Str.3, House 41, 24105, Kiel, Germany.
authors: Ulf
authors: U
authors: Jensen-Kondering
authors: Neuroradiology, Medical Radiological Institute, Zurich, Switzerland.
authors: Stephan
authors: S
authors: Ulmer
authors: Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein (UKSH), Arnold-Heller-Str.3, House 41, 24105, Kiel, Germany.
authors: Olav
authors: O
authors: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Cerebral artery dissection; Cerebral infarction; Interventional neuroradiology; Magnetic resonance vessel wall imaging; Subarachnoid hemorrhage