Lee Jong-Myong
Department of Neurosurgery, Jeonbuk National University Hospital and Medical School, Jeon-Ju, Korea.
Radiol Case Rep. 2022 May 13;17(7):2537-2541. doi: 10.1016/j.radcr.2022.04.020. eCollection 2022 Jul.
We report a case of subarachnoid hemorrhage due to a dissecting middle cerebral artery that was misdiagnosed as saccular aneurysm. A 74-years old female patient presented with headache and neck pain for 4 days. Brain magnetic resonance imaging revealed subarachnoid hemorrhage in both Sylvian fissures. A ruptured left middle cerebral artery bifurcation saccular aneurysm and unruptured basilar tip aneurysm were diagnosed. The patient was treated surgically using the transsylvian approach. However, no saccular aneurysm was found during the surgery, and the diagnosis was corrected for middle cerebral artery dissection. We treated the dissected segment of the middle cerebral artery and performed clip reinforcement. We experienced a case of middle cerebral artery dissection with no neurological deficit, which was misdiagnosed as a saccular aneurysm. If the stump of the occlusion is conical, dissection should be suspected. High-resolution magnetic resonance imaging and angiography should be performed for a differential diagnosis if dissection is suspected.
我们报告一例因大脑中动脉夹层导致的蛛网膜下腔出血，该病例曾被误诊为囊状动脉瘤。一名74岁女性患者出现头痛和颈部疼痛4天。脑部磁共振成像显示双侧外侧裂蛛网膜下腔出血。诊断为左侧大脑中动脉分叉处囊状动脉瘤破裂及基底动脉尖未破裂动脉瘤。患者接受了经外侧裂入路的手术治疗。然而，手术中未发现囊状动脉瘤，诊断被修正为大脑中动脉夹层。我们对大脑中动脉的夹层段进行了治疗并进行了夹闭加固。我们遇到了一例无神经功能缺损的大脑中动脉夹层病例，该病例曾被误诊为囊状动脉瘤。如果闭塞残端呈圆锥形，应怀疑夹层。如果怀疑夹层，应进行高分辨率磁共振成像和血管造影以进行鉴别诊断。
