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Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features

H Ohkuma1, S Suzuki, N Shimamura

  • 1Department of Neurosurgery, Hirosaki University School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Japan. ohkuma@cc.hirosaki-u.ac.jp

Neuroradiology
|April 10, 2003
PubMed

Insights

Nontraumatic dissecting aneurysms of the middle cerebral artery (MCA) are rare. This study analyzed 13 MCA dissecting aneurysm cases, revealing distinct features in ischemic versus hemorrhagic presentations and highlighting a poor prognosis for rebleeding.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Radiology

Background:

  • Nontraumatic dissecting aneurysms of the middle cerebral artery (MCA) are infrequently reported.
  • Limited analysis exists on the neuroradiological and clinical characteristics of these aneurysms.

Observation:

  • A collaborative study reviewed 13 patients with MCA dissecting aneurysms diagnosed between 1995 and 1999.
  • Four patients presented with cerebral ischemia, and nine with bleeding.
  • Younger patients (<15 years) were noted in the ischemic group.

Findings:

  • Cerebral angiography in ischemic cases revealed M1 segment stenosis and double lumen.
  • MR angiography confirmed findings of intra-arterial angiography.
  • CT/MRI showed infarcts in the M1 perforating branches territory for ischemic cases.
  • Hemorrhagic cases showed subarachnoid hemorrhage or sylvian fissure hematoma on CT.
  • Angiography in hemorrhagic cases demonstrated dilatation with stenosis, with variable lesion sites.
  • A double lumen or intimal flap was observed in approximately half of all cases.
  • Five of nine hemorrhagic patients experienced rebleeding within 14 days, indicating a poor prognosis.

Implications:

  • Understanding the distinct neuroradiological and clinical features of MCA dissecting aneurysms is crucial for diagnosis and management.
  • The high rate of rebleeding in hemorrhagic cases underscores the need for prompt and effective treatment strategies.
  • Further research into the etiology and optimal treatment of these rare aneurysms is warranted.

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