Lanzino G, Kaptain G, Kallmes D F, Dix J E, Kassell N F
Department of Neurosurgery, Virginia Neurological Institute, University of Virginia, Charlottesville 22908, USA.
Surg Neurol. 1997 Nov;48(5):477-81. doi: 10.1016/s0090-3019(97)00178-x.
With increasing frequency, dissecting aneurysms of the intracranial arteries are recognized as a possible cause of subarachnoid hemorrhage (SAH). In the presence of a dissecting aneurysm, angiographic changes may be subtle at presentation and correct diagnosis often requires serial angiograms. We report a patient with a dissecting aneurysm of the anterior cerebral artery (ACA) causing SAH, in whom less invasive diagnostic tools, such as high-resolution computerized tomographic angiography (CTA) and magnetic resonance angiography (MRA), were helpful in confirming the diagnosis and in following the evolution of the dissection.
We present this 51-year old woman who experienced the sudden onset of severe headache without associated neurological deficits. Head CT showed SAH with blood in the interhemispheric fissure, suggesting a ruptured ACA aneurysm. Serial cerebral angiograms failed to demonstrate an aneurysmal sac, but showed evolving irregularities of the ACA consistent with a dissecting aneurysm. These findings were confirmed by CTA and MRA. The patient was treated conservatively and made an excellent recovery. A MRA obtained 2 months later showed slight improvement of the previously visualized ACA dilatation.
Serial angiograms are often required to confirm the diagnosis and to follow the evolution of an intracranial dissection. With recent advances in neuroradiological techniques, however, critical information can be obtained by less invasive imaging studies, such as CTA and MRA.
颅内动脉夹层动脉瘤作为蛛网膜下腔出血（SAH）的一个可能病因，其发现频率日益增加。在存在夹层动脉瘤的情况下，血管造影改变在发病时可能很细微，正确诊断通常需要系列血管造影。我们报告一例大脑前动脉（ACA）夹层动脉瘤导致SAH的患者，在该病例中，高分辨率计算机断层血管造影（CTA）和磁共振血管造影（MRA）等侵入性较小的诊断工具有助于确诊并跟踪夹层的演变。
我们介绍这位51岁女性，她突然出现严重头痛，无相关神经功能缺损。头部CT显示SAH，大脑半球间裂有血液，提示ACA动脉瘤破裂。系列脑血管造影未能显示动脉瘤囊，但显示ACA有逐渐演变的不规则改变，符合夹层动脉瘤。这些发现经CTA和MRA证实。患者接受保守治疗，恢复良好。2个月后进行的MRA显示，之前所见的ACA扩张略有改善。
通常需要系列血管造影来确诊并跟踪颅内夹层的演变。然而，随着神经放射学技术的最新进展，通过CTA和MRA等侵入性较小的影像学检查可以获得关键信息。
