Subarachnoid Hemorrhage in the Presence of Both Intracranial Dissecting and Saccular Aneurysms : Two Case Reports

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概要

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• Two patients presented with subarachnoid hemorrhage (SAH) associated with both intracranial dissecting and saccular aneurysms. Case 1, a 48-year-old woman, had a saccular aneurysm of the right internal carotid artery and dissecting aneurysms of the bilateral vertebral arteries. Case 2, a 52-year-old man, had three saccular aneurysms in the anterior circulation and a dissecting aneurysm of the unilateral vertebral artery. A saccular aneurysm was responsible for the SAH in both patients. Ruptured saccular aneurysms were treated with surgical clipping and unruptured dissecting aneurysms remained untreated. SAH recurred due to bleeding from an untreated dissecting aneurysm 4 days after the initial SAH in Case 1. Triple-H therapy, which causes increased hemodynamic stress, was not administered for symptomatic cerebral vasospasm after SAH in Case 2, because of the risk of bleeding from the untreated dissecting aneurysm, and the patient suffered cerebral infarction. The risk factors for this rare association are unclear, but both patients were smokers and had hypocholesterolemia including low apolipoprotein E levels. The clinical management of patients with SAH and both dissection and saccular aneurysms is complicated. Asymptomatic dissecting aneurysm has a benign clinical course in general, but hemodynamic stress related to stroke may induce abrupt development of dissecting aneurysms. Prophylactic obliteration during the acute stage of SAH may provide better outcomes if the unruptured dissecting lesion appears as obvious aneurysmal dilatation or pearl-and-string sign and is safely treatable with endovascular trapping.

• 社団法人 日本脳神経外科学会の論文
• 2007-02-15

著者

• MIYAZAKI Takeshi

  Department of Neurosurgery, Faculty of Medicine, Shimane University

• Moritake Kouzo

  Department of Neurosurgery, Shimane Medical University

• NAGAI Hidemasa

  Department of Neurosurgery, Shimane University School of Medicine

• Miyazaki Takeshi

  Department Of Neurosurgery Shimane University Faculty Of Medicine

• AKIYAMA Yasuhiko

  Department of Neurosurgery, Shimane University School of Medicine

• Akiyama Yasuhiko

  Department Of Neurosurgery Shimane University School Of Medicine

• Akiyama Yasuhiko

  Department Of Neurosurgery Kokura Memorial Hospital:(present Address)department Of Neurosurgery Shim

• Moritake Kouzo

  Department Of Neurosurgery Kyoto University

• Nagai Hidemasa

  Department Of Neurosurgery Shimane University School Of Medicine

• Moritake Kouzo

  Department Of Neurosurgery Shimane University Faculty Of Medicine

• Moritake Kouzo

  Department Of Neurosurgery Shimane University School Of Medicine Izumo Shimane

• Nagai Hidemasa

  Department Of Biochemistry Faculty Of Medicine Shimane University

• Miyazaki Takeshi

  Department Of Neurosurgery Faculty Of Medicine Shimane University

• Miyazaki Takeshi

  Department Of Materials Science And Technology Nagaoka University Of Technology

• Akiyama Yasuhiko

  Department Of Neurosurgery Faculty Of Medicine Shimane University

• Miyazaki Takeshi

  Department of Applied Chemistry, Faculty of Engineering, Osaka University

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