Iwashita Tomomi, Kitazawa Kazuo, Koyama Jun-Ichi, Nagashima Hisashi, Koyama Toru, Tanaka Yuichiro, Hongo Kazuhiro
Department of Emergency and Intensive Care Medicine, Shinshu University School of Medicine, Matsumoto 390-8621, Japan.
Surg Neurol. 2005 Dec;64(6):538-41, discussion 541. doi: 10.1016/j.surneu.2005.01.023.
A rare case of a growing dissecting aneurysm, which was located at the horizontal (A1) segment of the anterior cerebral artery (ACA), is reported.
A 53-year-old woman experienced left hemiparesis and alien hand syndrome. A computerized tomography scan showed an infarction in the right frontal lobe, and cerebral angiography revealed a false lumen and intimal flap at the A1 segment of the ACA. Magnetic resonance angiography demonstrated that the stenosis progressed 6 months later and improved 1 year later. Cerebral angiography showed a saccular-like aneurysm 2 years later. The surgery was planned for prevention of aneurysmal rupture. The aneurysm, which was cocoon shaped, was exposed surgically and was resected. Histological examination of the aneurysm showed arterial dissection. The postoperative course was uneventful without additional neurological deficits.
This is the first case report of A1 dissecting aneurysm presenting with an ischemic event in the literature. The sequential change of the configuration was curious to develop aneurysmal dilatation in 2 years. Long-term follow-up is necessary even after disappearance of the arterial dissection.
报道了一例罕见的生长性夹层动脉瘤，位于大脑前动脉（ACA）的水平段（A1段）。
一名53岁女性出现左侧偏瘫和异手综合征。计算机断层扫描显示右侧额叶梗死，脑血管造影显示ACA的A1段有假腔和内膜瓣。磁共振血管造影显示6个月后狭窄进展，1年后改善。2年后脑血管造影显示一个囊状动脉瘤。计划进行手术以预防动脉瘤破裂。该动脉瘤呈茧形，通过手术暴露并切除。对动脉瘤的组织学检查显示为动脉夹层。术后过程顺利，无额外神经功能缺损。
这是文献中首例以缺血性事件为表现的A1段夹层动脉瘤病例报告。其形态的连续变化在2年内发展为动脉瘤扩张，这很奇特。即使动脉夹层消失后，也需要长期随访。
