A Case of Dissecting Aneurysm of the Vertebro-Basilar Artery with Brain Stem Ischemia and Subarachnoid Hemorrhage

Abstract

We report a case of large dissecting aneurysm of vertebro-basilar (VB) artery with brain stem ischemia and subarachnoid hemorrhage. This 58-year-old man was admitted because of sudden onset of left hemiparesis and left hemisensory disturbance. The initial CT scan was normal except for a large high-density spot anterior to the brain stem, and angiography revealed a dolichoectatic VB artery and large irregular shaped dissecting aneurysm that extended from the right vertebral to the basilar artery. MRI showed double lumen and intimal flap in the aneurysm. Although ischemic symptoms had disappeared within 2 days, the patient suddenly became comatose 4 days after admission and massive subarachnoid hemorrhage was confirmed on CT scan. Follow-up angiography at 6 months showed disappearance of double contrast of the VB artery detected at onset. Ten months later, on MRI, the false lumen had been enlarged and thrombus of variable phase had been piled in many layers within it. The brain stem was compressed and distorted markedly. The patient died after being a vegetative state for a year and 4 months.