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Dissecting aneurysms of intracranial carotid circulation
Hiroki Ohkuma1, Shigeharu Suzuki, Kazumi Ogane
1Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Japan. ohkuma@cc.hirosaki-u.ac.jp
Insights
Nontraumatic dissecting aneurysms of the intracranial carotid circulation are more common than previously thought, often causing subarachnoid hemorrhage. These aneurysms present with varied clinical features and have a high rate of poor prognosis, frequently due to rebleeding.
Area of Science:
- Neurology
- Vascular Neurology
- Neurosurgery
Background:
- Nontraumatic dissecting aneurysms of the intracranial carotid circulation are poorly understood due to limited case report investigations.
- Clinical features of this condition remain unclear, necessitating a broader analysis.
Purpose of the Study:
- To investigate the clinical features of nontraumatic dissecting aneurysms of the intracranial carotid circulation.
- To analyze cooperatively collected cases to better understand this disease.
Main Methods:
- Collected cases diagnosed with dissecting aneurysms of the intracranial carotid circulation from 46 stroke centers (1995-1999).
- Analyzed clinical signs and neuroradiological findings of 49 collected cases.
- Determined the ratio of these aneurysms to all intracranial dissecting aneurysms and to subarachnoid hemorrhage of unverified origin.
Main Results:
- Forty-nine cases were analyzed, with 32 presenting subarachnoid hemorrhage (SAH) and 17 with cerebral ischemia.
- Predominant lesion sites included the internal carotid artery (56% with SAH) and anterior cerebral artery (76% with cerebral ischemia).
- Angiographic findings varied, with stenosis and dilatation common in SAH cases (63%), and stenosis without dilatation in ischemic cases (65%). Poor prognosis was observed in 66% of SAH patients, often due to rebleeding.
Conclusions:
- Nontraumatic dissecting aneurysms of the intracranial carotid circulation are not rare and represent a significant cause of subarachnoid hemorrhage of unverified origin.
- Understanding the clinical features and outcomes is crucial for managing this condition.
Background And Purpose:
Clinical features of nontraumatic dissecting aneurysms of intracranial carotid circulation remain unclear because investigation of this disease has been limited to case reports. The aim of this study was to investigate the clinical features of this disease through the use of cooperatively collected cases.
Methods:
The cases diagnosed as dissecting aneurysms of intracranial carotid circulation on the basis of clinical signs and neuroradiological findings in 46 stroke centers from 1995 through 1999 were collected, and their clinical features were analyzed.
Results:
Forty-nine cases of dissecting aneurysms of intracranial carotid circulation were collected. Thirty-two patients presented with subarachnoid hemorrhage (SAH), and 17 presented with cerebral ischemia. The ratio of this disease to all intracranial dissecting aneurysms treated in the same institutes for the same period was 19.1%, and the ratio of SAH resulting from this disease to SAH of unverified origin treated in the same institutes for the same period was 6.2%. The predominant site of lesion was the internal carotid artery in 18 of 32 patients (56%) with SAH and the anterior cerebral artery in 13 of 17 patients (76%) with cerebral ischemia. The predominant angiographic findings were that stenosis with dilatation occurred in 20 of 32 patients (63%) with SAH and stenosis without dilatation was seen in 11 of 17 patients (65%) with cerebral ischemia. Poor prognosis was seen in 21 of 32 patients (66%) with SAH, which was due largely to rebleeding seen preoperatively, during operation, and even postoperatively when clipping or wrapping of the aneurysmal bulge was performed.
Conclusions:
Nontraumatic dissecting aneurysm of intracranial carotid circulation is not as rare as expected. It seems to be one of the important causes of SAH of unverified origin.