Puri Ajit S, Gounis Matthew J, Massari Francesco, Howk Mary, Weaver John, Wakhloo Ajay K
Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA.
Department of Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
BMJ Case Rep. 2015 Apr 1;2015:bcr2014011596. doi: 10.1136/bcr-2014-011596.
Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up.
孤立性大脑中动脉夹层是一种罕见的临床病症，相关描述仅限于少数病例报告和病例系列。前循环中的症状性夹层在年轻人群中可表现为缺血性卒中；然而，它很少与蛛网膜下腔出血相关。我们描述了一名年轻患者，其因蛛网膜下腔出血出现急性头痛，最终确定是由大脑中动脉的血管夹层所致。最初的血管造影显示该区域存在血管不规则伴狭窄。发病4天后的重复影像学检查发现狭窄近端有一个假性动脉瘤。该患者成功接受了自膨式镍钛合金支架治疗，并在术后住院恢复期间进行了系列血管造影随访；治疗后约1个月和6个月进行了额外的血管造影。系列血管造影显示夹层逐渐愈合。患者出院，在6个月的随访中神经功能保持完好。
