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[Spontaneous dissecting aneurysms of the cerebral arteries]
Insights
Spontaneous dissecting aneurysms (DA) of cerebral arteries often affect middle-aged individuals, presenting with neck pain or TIAs. Embolism and thrombus are likely causes, leading to recommendations for anticoagulant therapy.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroradiology
Background:
- Spontaneous dissecting aneurysms (DA) of cerebral arteries are a significant cause of neurological deficits.
- Extracranial internal carotid artery (ICA) DA commonly affects middle-aged patients, presenting with neck/face pain and transient ischemic attacks (TIAs).
Purpose of the Study:
- To review the literature on spontaneous DA of cerebral arteries.
- To present three personal cases of ICA DA.
- To discuss the etiology, clinical presentation, and management of cerebral artery DA.
Main Methods:
- Literature review of spontaneous dissecting aneurysms.
- Clinical, radiological, and pathological data analysis of three internal carotid artery DA cases.
Main Results:
- Extracranial ICA DA patients (30-60 years) often experience ipsilateral neck/face pain (45%) and TIAs (50%).
- Neurological deficits are primarily attributed to embolism or thrombus, supporting anticoagulant therapy.
- Vertebral artery DA treatment remains debated, while intracranial DA often results in severe outcomes and subarachnoid hemorrhage.
Conclusions:
- Spontaneous DA of cerebral arteries requires careful management, with anticoagulation as a primary treatment.
- Arterial wall pathologies like fibromuscular dysplasia and cystic medial necrosis are implicated in DA.
- Further research is needed for optimal treatment strategies for vertebral artery DA.
Abstract:
A review of the literature on Spontaneous Dissecting Aneurysms (DA's) of cerebral arteries is presented with 3 personal cases of DA's of the Internal Carotid Artery (ICA). Patients with spontaneous DA's of the extracranial ICA are of middle age (30 to 60 year old) and present with an ipsilateral pain in the neck or face and/or with TIAs (45 p. 100 and 50 p. 100 of the cases respectively). Claude Bernard-Horner's sign is frequent. The clinical, radiological and pathological data suggest that in most cases, if not all, neurological deficits are due to embolism and/or anterograde thrombus. This has led to recommend anticoagulant therapy. Nevertheless, surgery may be indicated is some situations such as in DA's on kinking arteries. The treatment of spontaneous DA's of extracranial vertebral arteries is still a detectable matter, though they have common features with DA's of the extracranial ICA. The DA's of the basilar and intracranial vertebral arteries are often associated with a subarachnoid haemorrhage and most of them have a severe outcome. Lesions of the arterial wall such as cystic medial necrosis and fibromuscular dysplasia play a role in the extent, and presumably in the initiation, of the so-called spontaneous DA's at least in some cases. Minor trauma, high blood pressure (20 p. 100 of the cases), oral contraceptives and coughing have been as well suspected.