Characteristics of Cerebral Infarction Due to Anterior Cerebral Artery Dissection: A Review of 16 Cases

Intracranial artery dissection is a recognized cause of cerebral infarction and subarachnoid hemorrhage. In Japan, anterior cerebral artery dissection (ACD) represents one of the causes leading to ischemia. This study compares our clinical experience with existing literature to characterize the distinctive features of ischemia-onset anterior cerebral artery dissection (infarction-anterior cerebral artery dissection (iACD)).

We conducted a retrospective analysis of 16 iACD cases identified among 2,776 cerebral infarction patients hospitalized between 2010 and 2019. Comprehensive imaging evaluations were performed at onset and systematically followed at two weeks, four weeks, one month, three months, six months, and 12 months post-onset.

The patient cohort had a mean age of 59.1 ± 11.2 years, with six patients (37.5%) being female. Clinical presentation included aphasia in four patients (25.0%), while headache, typically considered characteristic of dissection, was reported in only one patient. Magnetic resonance imaging demonstrated intramural hematoma in 10 patients (62.5%), all confirmed during the second week following onset. Therapeutic management consisted of blood pressure control in all cases, with adjunctive antithrombotic therapy using cilostazol administered to five patients (31.3%). No patients developed progression to dissecting aneurysms or subarachnoid hemorrhage. While radiological deterioration occurred in the form of worsening stenosis (11 patients, 68.8%) and enlargement of cerebral infarcts (15 patients, 93.8%), and clinical deterioration manifested as worsening neurological symptoms in four patients (25.0%), none of these adverse events correlated with long-term prognosis.

Our findings diverge from previous reports in two significant aspects: iACD affects elderly populations more commonly than previously recognized, and the classic presenting symptom of headache is notably infrequent. Clinicians should maintain a high index of suspicion for ACD when evaluating cerebral infarction in the anterior cerebral artery territory, even in the absence of typical findings such as headache or age.