Chronic recanalization of dissection of the distal anterior cerebral artery: case report and review of the literature

Abstract

The natural history of atraumatic idiopathic dissection of the distal anterior cerebral artery is still unclear. We present a 38-year-old man who had dissection of the left A(2) segment of this vessel associated with subintimal hematoma and infarction. Because of complete stroke in acute stage, he did not undergo surgery. About three months later, administration of aspirin (100 mg/day) was started. At nine months, magnetic resonance angiography revealed complete recanalization of the A(2) dissection. To assess the outcome of dissection, we should observe the patient for at least one year.

Figure 1

Imaging findings on the day of onset. (a) Computed tomography shows very thin subarachnoid hemorrhage on the left side of the interhemispheric fissure (arrow). (b) Magnetic resonance imaging (diffusion image) reveals infarction of the left medial frontal region (arrow). (c) Left internal cerebral artery angiography reveals stenosis (string sign) of the A₂ segment (arrow).

Figure 2

(a) Magnetic resonance imaging (FLAIR sequence) about one month after the onset shows infarction of the medial part of the left frontal lobe. (b) Left internal cerebral artery angiogram displays severe stenosis of the A₂ segment (arrow). (c) About 9 months after the onset, magnetic resonance angiography reveals recanalization of the left A₂ segment.