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[A case of anterior cerebral artery dissection causing hemorrhagic infarction]

Masahiro Oomura1, Tadashi Terai, Koji Shigeno

  • 1Department of Neurology, Shizuoka Municipal Shimizu Hospital.

Rinsho Shinkeigaku = Clinical Neurology
|February 18, 2005
PubMed

Insights

A spontaneous dissection of the left anterior cerebral artery (ACA) caused stroke symptoms. Hemorrhagic changes occurred during antiplatelet therapy, highlighting treatment controversies in cerebral artery dissection.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neuroimaging

Background:

  • Spontaneous dissection of intracranial arteries is a rare cause of stroke.
  • Cerebral artery dissection requires careful diagnostic and therapeutic considerations.

Observation:

  • A 56-year-old man presented with right arm and leg weakness and headache.
  • Brain CT revealed low density areas in the left frontal lobe.
  • Cerebral angiography showed the "pearl and string sign" in the left anterior cerebral artery (ACA), indicative of dissection.

Findings:

  • The patient was diagnosed with spontaneous ACA dissection and treated with antiplatelet therapy.
  • Serial imaging demonstrated hemorrhagic transformation of the infarct.
  • The ACA dissection showed improvement on follow-up angiography.
  • Hemorrhagic changes were possibly due to reperfusion injury from intramural hematoma absorption.

Implications:

  • Antithrombotic therapy in cerebral artery dissection is controversial due to the risk of hemorrhagic complications.
  • Hemorrhagic infarction and subarachnoid hemorrhage are potential risks.
  • Further case accumulation is needed to guide treatment strategies for cerebral infarction due to dissection.

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