Article Text

PDF
Case report
Monotherapy with stenting in subarachnoid hemorrhage (SAH) after middle cerebral artery dissection
  1. Ajit S Puri1,
  2. Matthew J Gounis1,
  3. Francesco Massari1,
  4. Mary Howk1,
  5. John Weaver2,
  6. Ajay K Wakhloo1
  1. 1Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, USA
  2. 2Department of Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  1. Correspondence to Dr Ajit S Puri, Department of Radiology, New England Center for Stroke Research and Division Neuroimaging and Intervention, Worcester, Massachusetts, 01655, USA; Ajit.Puri{at}umassmemorial.org

Abstract

Isolated middle cerebral artery dissection is a rare clinical entity, with descriptions limited to a few case reports and case series. Symptomatic dissection in the anterior circulation can present as an ischemic stroke in a young population; however, it is rarely associated with subarachnoid hemorrhage. We describe a young patient who presented with acute headache from a subarachnoid hemorrhage that was ultimately determined to be due to a vascular dissection in the middle cerebral artery. The initial angiogram showed vascular irregularities in this area with stenosis. Repeat imaging 4 days after presentation identified a pseudoaneurysm proximal to the stenosis. The patient was successfully treated with a self-expanding nitinol stent and followed up with serial angiography during postoperative recovery in the hospital; additional angiograms were performed approximately 1 and 6 months after treatment. Serial angiograms demonstrated incremental healing of the dissection. The patient was discharged and remains neurologically intact at the 6-month follow-up.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.