Hagihara Ryota, Arai Hiroshi, Yamada Shintaro, Hirose Satoshi
Department of Neurosurgery, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Fukui, Japan.
Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan.
NMC Case Rep J. 2024 Jul 27;11:213-219. doi: 10.2176/jns-nmc.2024-0072. eCollection 2024.
A 79-year-old woman presented at our hospital with sudden headache and vomiting. Computed tomography revealed diffuse subarachnoid hemorrhage. Although digital subtraction angiography (DSA) performed on admission and on the following day revealed no vascular abnormalities, DSA on Day 22 revealed microaneurysmal changes in the dorsal basilar artery. However, the aneurysmal changes gradually became smaller during follow-up, and DSA on Day 73 revealed complete disappearance. A 53-year-old man also presented to our hospital with sudden headache and vomiting. Computed tomography revealed perimesencephalic subarachnoid hemorrhage. DSA on Days 9 and 16 revealed microaneurysmal changes in the dorsal basilar artery. Conservative treatment was continued, and DSA on Day 42 revealed spontaneous disappearance of the lesion. It has been reported that basilar artery perforating aneurysms cause angiogram-negative subarachnoid hemorrhage, which disappears spontaneously. The fact that lesions previously reported as basilar artery perforating aneurysms may include cases of acute dissection of the main trunk or perforating branches of the basilar artery implies that surgical or endovascular treatment may worsen the condition. Therefore, conservative treatment may be an important option.
一名79岁女性因突发头痛和呕吐前来我院就诊。计算机断层扫描显示弥漫性蛛网膜下腔出血。尽管入院时及次日进行的数字减影血管造影（DSA）未发现血管异常，但第22天的DSA显示基底动脉背侧有微动脉瘤改变。然而，在随访期间动脉瘤改变逐渐变小，第73天的DSA显示完全消失。一名53岁男性也因突发头痛和呕吐前来我院就诊。计算机断层扫描显示中脑周围蛛网膜下腔出血。第9天和第16天的DSA显示基底动脉背侧有微动脉瘤改变。继续进行保守治疗，第42天的DSA显示病变自发消失。据报道，基底动脉穿通性动脉瘤可导致血管造影阴性的蛛网膜下腔出血，且会自发消失。先前报道为基底动脉穿通性动脉瘤的病变可能包括基底动脉主干或穿支急性夹层的病例，这一事实表明手术或血管内治疗可能会使病情恶化。因此，保守治疗可能是一个重要的选择。
