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Case Reports
. 2016 Sep;18(3):271-275.
doi: 10.7461/jcen.2016.18.3.271. Epub 2016 Sep 30.

Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

Min Hyung Lee  1 , Sang Uk Kim  1 , Dong Hoon Lee  1 , Young Il Kim  1 , Chul Bum Cho  1 , Seung Ho Yang  1 , Il Sup Kim  1 , Jae Taek Hong  1 , Jae Hoon Sung  1 , Sang Won Lee  1
Affiliations
Case Reports

Evaluation and Treatment of the Acute Cerebral Infarction with Convexal Subarachnoid Hemorrhage

Min Hyung Lee et al. J Cerebrovasc Endovasc Neurosurg. 2016 Sep.

Abstract

Non-traumatic convexal subarachnoid hemorrhage (CSAH) is a comparatively infrequent with various vascular and nonvascular causes, it rarely occurs concomitant to acute ischemic stroke. We report a case of a 59-year-old woman, visited emergency room with right side subjective weakness spontaneously. Magnetic resonance diffusion-weighted images revealed an acute infarction of anterior cerebral arterial territory. Computed tomographic angiography showed a left frontal CSAH without any vascular lesions. And other laboratory studies were non-specific. We treated with dual antiplatelet drugs (cilostazole [Otsuka Pharmaceutical Co., Ltd. tokyo, Japan] and Aspirin [Bayer Pharma AG., Leverkusen, Germany]). She has done well for a follow-up period. (5 months) This case demonstrates the CSAH with acute infarction is rare but need to work up to identify the etiology and antiplatelet dugs are taken into account for treatments.

Keywords: Antiplatelet drug; Computed tomographic angiography; Convexal subarachnoid hemorrhage; Ischemic stroke.

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Conflict of interest statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Fig. 1
Fig. 1. (A) Computed tomography scan of the patient showing subarachnoid hemorrhage (black arrow) on left frontal convexity. (B) CT angiography shows that both A2 segments were mild focal stenosis (white arrow). (C) Diffusion-weighted images shows a high intensity area in the territory of left anterior cerebral artery. (D) Brain SPECT with Tc-99 m HMPAO shows a small area of decreased perfusion at left frontal area. CT = computed thmography; SPECT = single-photon emission computed tomography; HMPAO = hexamethylpropylene amine oxime; Lt = left; Rt = Right.
Fig. 2
Fig. 2. (A) Computed tomography shows that low intensity of previous ACA infarction territory (black arrow) and no high intensity presenting SAH on left frontal convexity. (B) and (C) there is no evidence of acute infarction in DWI and hemorrhagic transformation in SWI. ACA = anterior cerebral artery; SAH = subarachnoid hemorrhage; DWI = diffusion-weighted images; SWI = susceptibility weighted imaging.
See this image and copyright information in PMC

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