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. 2017 Jul;14(1):155-158.
doi: 10.3892/etm.2017.4462. Epub 2017 May 17.

Good recovery of subarachnoid hemorrhage concomitant with ischemia due to anterior cerebral artery dissection by conservative treatment: A case report

Yiqi Wang  1 , Yu Geng  1 , Zongjie Shi  1 , Tianming Shi  1 , Jinhua Zhang  1
Affiliations

Good recovery of subarachnoid hemorrhage concomitant with ischemia due to anterior cerebral artery dissection by conservative treatment: A case report

Yiqi Wang et al. Exp Ther Med. 2017 Jul.

Abstract

The present report describes the case of a 57-year-old woman presenting with subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) due to anterior cerebral artery (ACA) dissection, which exhibited severe stenosis at the origin with distal dilatation of the A2 segment and occlusion of the A3 segment. In this case, computed tomography (CT) revealed SAH in right superior frontal sulcus and the interhemispheric fissure. Magnetic resonance imaging demonstrated acute infarct in the territory of the right ACA. Brain digital subtraction angiography showed severe stenosis at the origin of the A2 segment with distal dilatation and occlusion at the origin of the A3 segment of the right ACA, suggesting a diagnosis of dissection. Only treatment with atorvastatin, her clinical condition subsequently improved. The stenosis and dilatation of A2 segment were ameliorated as demonstrated by a follow-up CT angiography 5 months after onset. SAH concomitant with ischemia caused by ACA dissection is rare. Conservative treatment may be a safe and effective choice for patients with SAH concomitant with AIS due to ACA dissection.

Keywords: acute ischemic stroke; anterior cerebral artery; conservative treatment; dissection; subarachnoid hemorrhage.

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Figures

Figure 1.
Figure 1.
(A) On day 1 after onset, computed tomography demonstrated subarachnoid hemorrhage in the right superior frontal sulcus (black arrow) and right interhemispheric fissure (white arrow). (B) On day 2 after onset, diffusion weighted imaging sequences of magnetic resonance imaging showed hyperintense lesions in the territory of the right anterior cerebral artery (black arrow).
Figure 2.
Figure 2.
(A) CT angiography on day 5 after onset showed severe stenosis at the origin of the A2 segment (black arrow) with distal dilatation (white arrow) and occlusion at the origin of A3 segment of the right ACA. (B) Digital subtraction angiography on day 6 also showed severe stenosis at the origin of the A2 segment (black arrow) with distal dilatation (white arrow) and occlusion at the origin of the A3 segment of the right ACA (black arrow). (C) CT angiography after 5 months showed that the stenosis of A2 segment was considerably improved (black arrow) and the dilatation of A2 segment had almost disappeared (white arrow). CT, computed tomography; ACA, anterior cerebral artery.
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