Kimura Seigo, Yagi Ryokichi, Yamada Keiichi, Taniguchi Hirokatsu, Wanibuchi Masahiko
Neurosurgery, Kouzenkai Yagi Neurosurgical Hospital, Osaka, JPN.
Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, JPN.
Cureus. 2024 Sep 12;16(9):e69285. doi: 10.7759/cureus.69285. eCollection 2024 Sep.
A non-aneurysmal subarachnoid hemorrhage (SAH) due to an aplastic or twig-like middle cerebral artery (Ap/T-MCA) is extremely rare. We describe a case of a non-aneurysmal SAH due to an Ap/T-MCA. A 38-year-old female patient experienced a sudden severe headache and was admitted to our hospital. A head CT scan revealed an SAH. Cerebral angiography revealed a non-aneurysmal subarachnoid hemorrhage due to an Ap/T-MCA. The patient was treated conservatively and had a good recovery. Because of the complexity of the vascular structure, we had difficulty in making a diagnosis of our case. Cone beam CT and M1 selective angiography using a microcatheter were useful for the diagnosis of an Ap/T-MCA. An extracranial-intracranial bypass (EC-IC) may effectively treat a non-aneurysmal SAH due to an Ap/T-MCA. However, the evidence of the effectiveness of EC-IC bypass surgeries for non-aneurysmal SAHs due to Ap/T-MCAs is insufficient, and further case accumulation is needed.
由发育不全或树枝状大脑中动脉（Ap/T-MCA）导致的非动脉瘤性蛛网膜下腔出血（SAH）极为罕见。我们描述了一例由Ap/T-MCA导致的非动脉瘤性SAH病例。一名38岁女性患者突发剧烈头痛，被收治入院。头部CT扫描显示为SAH。脑血管造影显示为Ap/T-MCA导致的非动脉瘤性蛛网膜下腔出血。该患者接受了保守治疗，恢复良好。由于血管结构复杂，我们对该病例的诊断存在困难。锥形束CT和使用微导管的M1选择性血管造影对Ap/T-MCA的诊断很有帮助。颅外-颅内搭桥术（EC-IC）可能有效治疗由Ap/T-MCA导致的非动脉瘤性SAH。然而，EC-IC搭桥手术对由Ap/T-MCA导致的非动脉瘤性SAH有效性的证据不足，需要进一步积累病例。
