title: Ruptured dissecting aneurysms of the A1 segment of the anterior cerebral artery: three case reports and a review of the literature.
abstract: Dissecting aneurysms in the anterior cerebral artery (ACA), although rare, can cause ischemic and/or hemorrhagic stroke. Hemorrhagic dissecting aneurysms in the A1 portion of the ACA are often associated with a poor prognosis. We retrospectively investigated three rare cases of hemorrhagic dissecting aneurysms in the A1 portion. Dissecting aneurysms were diagnosed by carotid angiography or computed tomography angiography to visualize morphological changes in the vessel. All patients presented with diffuse subarachnoid hemorrhage. In one case, computed tomography angiography performed at the onset of the subarachnoid hemorrhage revealed fusiform dilatation at the right ACA (A1), which did not appear on a magnetic resonance angiogram obtained 1 year prior to the onset of the subarachnoid hemorrhage. In the other two cases, A1 dissecting aneurysms were diagnosed from a growing aneurysmal bulge revealed at a non-bifurcated site via repeated carotid angiography. Two patients underwent surgical intervention (trapping or clipping), and their outcome was favorable, whereas the third patient died of delayed rebleeding before receiving surgical treatment. Hemorrhagic dissecting aneurysms in the A1 portion cause severe subarachnoid hemorrhage. Surgical treatments that include revascularization are necessary to prevent rebleeding, and direct surgery is recommended, particularly at the A1 portion.
authors.affiliation: Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan. t_mitsuhara@yahoo.co.jp.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Mitsuhara
authors.affiliation: Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
authors.forename: Fusao
authors.initials: F
authors.lastname: Ikawa
authors.affiliation: Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Hidaka
authors.affiliation: Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kurokawa
authors.affiliation: Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
authors.forename: Ushio
authors.initials: U
authors.lastname: Yonezawa
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000601:surgery; D013525:Surgical Instruments
keywords: Acute stroke; Anterior cerebral artery; Diagnosis and treatment of acute hemorrhage; Dissecting aneurysm; Neurosurgery; Subarachnoid hemorrhage