A Case of Anterior Cerebral Artery Dissecting Aneurysm Presenting Subarachnoid Hemorrhage

Abstract

Dissecting aneurysms in the anterior circulation most frequently involve the middle cerebral artery and the supraclinoid carotid artery. However, spontenous dissecting aneurysms of the anterior cerebral artery (ACA) are extremely rare. We report a case of the dissecting aneurysm of the right ACA inducing subarachnoid hemorrhage (SAH). An extensive search of the literature, revealed only 19 cases of dissecting aneurysm of the ACA to date, and 5 patients, including our case, had SAH. A 58-year-old female suddenly developed loss of conciousness with severe headache. A CT scan showed diffuse SAH. A cerebral angiogram revealed a bulbous post-stenotic dilatation in the right Al portion. The patient underwent a right frontal craniotomy, and a sausage like dilatation was found in the proximal 5-mm segment of the right Al portion. The dilatation was thin and purplish red in appearance. Dissecting aneurysm of the Al was diagnosed from findings of both angiography and operation. The dissecting aneurysm was trapped without arterial reconstruction. Postoperative recovery was uneventful but vasospasm developed. The patient was discharged with slight right hemiparesis three months after the operation.