Spontaneous dissecting aneurysm of middle cerebral artery: a case report with review of the literature.

We report a case of a dissecting aneurysm of the middle cerebral artery (MCA) and its treatment strategies. A 50-year-old male patient presented with occipital and neck pain for 2 days. CT scan revealed subarachnoid hemorrhage (SAH) in the region of the right sylvian fissure. A left carotid angiogram showed a dissecting aneurysm of the left MCA (M1). He was treated surgically by a pterional trans-sylvian approach. Clipping was done along with additional reinforcement by wrapping to completely obliterate the neck of the aneurysm. On reviewing the literature, we think that dissecting aneurysms seem to be one of the important causes of SAH and cerebral infarction of unverified origin. If an MCA dissecting aneurysm is identified, especially located in the proximal portion, surgical treatment must be considered. These patients merit a close follow-up.