Abstract
Introduction
Spontaneous dissections of intracranial arteries are rare, but important causes of stroke, especially in younger patients. Dissections of the anterior cerebral artery (ACA) have been reported only very rarely in the European and North American populations but might be more prevalent than previously thought.
Methods
This paper describes the presenting pattern of the disease, the clinical and imaging findings, as well as endovascular therapeutical options with respect to a meta-analysis of cases reported in the literature. Additionally, own observations in three recent representative cases are discussed.
Results
Overall, 80 cases from recent literature were included to the meta-analysis. The median age was 51 (35–82) years. Ischemia alone was described in 58 cases (73 %), subarachnoid hemorrhage (SAH) in 8 cases (10 %), and a combination of both in 14 cases (17 %). Radiological diagnosis including use of thin-layered 3T-MRI vessel wall imaging with black blood technique was verified by double lumen, by a string sign or string and pearl sign, or by a vessel wall hematoma in 23 (32 %), 62 (89 %), and 14 (20 %) cases, respectively. Interventional or surgical treatment was performed in 7 cases. A good clinical recovery was achieved in 77 % of cases.
Conclusion
Dissections of the ACA mostly cause ischemia, but can cause SAH or a combination of both in a relatively young population. Detailed neuroradiological diagnosis including 3T-MRI vessel wall imaging is required as a double lumen, isolated stenosis due to vessel wall hematoma, or the secondary development of a pseudoaneurysm might occur. Interventional therapy is the primary therapy for these vascular complications.
Similar content being viewed by others
References
Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8(7):668–678. doi:10.1016/S1474-4422(09)70084-5
Chung EM, Hague JP, Chanrion MA, Ramnarine KV, Katsogridakis E, Evans DH (2010) Embolus trajectory through a physical replica of the major cerebral arteries. Stroke 41(4):647–652. doi:10.1161/STROKEAHA.109.574400
Sato S, Toyoda K, Matsuoka H, Okatsu H, Kasuya J, Takada T, Shimode A, Uehara T, Naritomi H, Minematsu K (2010) Isolated anterior cerebral artery territory infarction: dissection as an etiological mechanism. Cerebrovasc Dis 29(2):170–177. doi:10.1159/000262314
Nagamine Y, Fukuoka T, Hayashi T, Kato Y, Deguchi I, Maruyama H, Horiuchi Y, Sano H, Mizuno S, Tanahashi N (2014) Research article: clinical characteristics of isolated anterior cerebral artery territory infarction due to arterial dissection. J Stroke Cerebrovasc Dis 23(10):2907–2913. doi:10.1016/j.jstrokecerebrovasdis.2014.07.017
Thines L, Zairi F, Taschner C, Leclerc X, Lucas C, Bourgeois P, Lejeune JP (2006) Subarachnoid hemorrhage from spontaneous dissection of the anterior cerebral artery. Cerebrovasc Dis 22(5–6):452–456. doi:10.1159/000095383
Kato Y, Hayashi T, Uchino A, Kakehi Y, Yamane F, Ishihara S, Tanahashi N (2014) Fusiform dilatation of the outer contour of a dissected anterior cerebral artery revealed by magnetic resonance cisternography in a patient with simultaneous cerebral infarction and subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 23(6):1717–1720. doi:10.1016/j.jstrokecerebrovasdis.2013.12.005
Ohkuma H, Suzuki S, Kikkawa T, Shimamura N (2003) Neuroradiologic and clinical features of arterial dissection of the anterior cerebral artery. AJNR Am J Neuroradiol 24(4):691–699
Suzuki K, Mishina M, Okubo S, Abe A, Suda S, Ueda M, Katayama Y (2012) Anterior cerebral artery dissection presenting subarachnoid hemorrhage and cerebral infarction. J Nippon Med School = Nippon Ika Daigaku zasshi 79(2):153–158
Im TS, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG (2014) Two cases of subarachnoid hemorrhage from spontaneous anterior cerebral artery dissection: a case of simultaneous hemorrhage and ischemia without aneurysmal formation and another case of hemorrhage with aneurysmal formation. J Cerebrovasc Endovasc Neurosurg 16(2):119–124. doi:10.7461/jcen.2014.16.2.119
Fukuma K, Ihara M, Tanaka T, Morita Y, Toyoda K, Nagatsuka K (2015) Intracranial cerebral artery dissection of anterior circulation as a cause of convexity subarachnoid hemorrhage. Cerebrovasc Dis 40(1–2):45–51. doi:10.1159/000430945
Fukuoka T, Kato Y, Ohe Y, Deguchi I, Maruyama H, Hayashi T, Tanahashi N (2014) A case of anterior cerebral artery dissection caused by scuba diving. J Stroke Cerebrovasc Dis 23(7):1982–1984. doi:10.1016/j.jstrokecerebrovasdis.2014.02.016
Inoue T, Fujimura M, Matsumoto Y, Kondo R, Inoue T, Shimizu H, Tominaga T (2010) Simultaneous occurrence of subarachnoid hemorrhage and cerebral infarction caused by anterior cerebral artery dissection treated by endovascular trapping. Neurol Med Chir 50(7):574–577
Kato T, Yagi T, Yoshioka H, Ogiwara M, Horikoshi T, Kinouchi H (2013) Simultaneous onset of anterior and middle cerebral artery dissections with an old vertebral artery dissection. J Stroke Cerebrovasc Dis 22(8):1229–1232. doi:10.1016/j.jstrokecerebrovasdis.2012.03.004
Kurino M, Yoshioka S, Ushio Y (2002) Spontaneous dissecting aneurysms of anterior and middle cerebral artery associated with brain infarction: a case report and review of the literature. Surg Neurol 57(6):428–436 discussion 436-428
Nagahata M, Seino H, Kakehata S, Morimoto K, Nakano T, Asano K, Shimamura N, Ohkuma H (2010) Dilated outer diameter of the dissected artery: acute bilateral anterior cerebral artery dissection evaluated by repeat magnetic resonance cisternography. Case report. Neurol Med Chir 50(12):1095–1098
Park YK, Yi HJ, Lee YJ, Kim YS (2013) Spontaneous anterior cerebral artery dissection presenting with simultaneous subarachnoid hemorrhage and cerebral infarction in a patient with multiple extracranial arterial dissections. J Korean Neurosurg Soc 53(2):115–117. doi:10.3340/jkns.2013.53.2.115
Shimoyama T, Kimura K, Iguchi Y, Shibazaki K, Watanabe M, Sakai K, Sakamoto Y, Aoki J (2011) Spontaneous intra-cranial arterial dissection frequently causes anterior cerebral artery infarction. J Neurol Sci 304(1–2):40–43. doi:10.1016/j.jns.2011.02.021
Kimura S, Igarashi T, Kotani A, Katayama Y (2010) Nontraumatic arterial dissection of the anterior cerebral artery with simultaneous cerebral infarction and subarachnoid hemorrhage: a case report. No shinkei geka Neurol Surg 38(3):273–278
Miyahara K, Sakata K, Gondo G, Kanno H, Yamamoto I (2001) Spontaneous dissection of the anterior cerebral artery presenting subarachnoid hemorrhage and cerebral infarction: a case report. No shinkei geka Neurol Surg 29(4):335–339
Nanbara S, Tsutsumi K, Takahata H, Fujimoto T, Kawahara I, Ono T, Toda K, Baba H, Yonekura M (2012) Spontaneous dissection of the anterior cerebral artery that simultaneously presented with cerebral infarction and subarachnoid hemorrhage, successfully treated with conservative management: a case report. No shinkei geka Neurol Surg 40(7):635–642
Oomura M, Terai T, Yamawaki T, Shigeno K (2005) A case of anterior cerebral artery dissection causing enlargement of infarction. Rinsho Shinkeigaku 45(10):762–765
Suzuki I, Nishino A, Nishimura S, Numagami Y, Suzuki H, Utsunomiya A, Suzuki S, Uenohara H, Sakurai Y (2005) Nontraumatic arterial dissection of the anterior cerebral artery: six cases report. No Shinkei = Brain Nerve 57(6):509–515
Ueda A, Hirano T, Katsura K, Makino K, Kai Y, Hamada J, Uchino M (2002) A case of juvenile cerebral infarction caused by bilateral anterior cerebral artery dissection. Rinsho Shinkeigaku 42(7):623–628
Ueyama K, Koyama S, Nakamura R (2011) Intracerebral and subarachnoid hemorrhages after administration of recombinant tissue plasminogen activator in a patient with acute ischemic stroke due to anterior cerebral artery dissection: a case report. Brain Nerve =Shinkei kenkyu no shinpo 63(6):605–610
Kwon JY, Kim NY, Suh DC, Kang DW, Kwon SU, Kim JS (2015) Intracranial and extracranial arterial dissection presenting with ischemic stroke: lesion location and stroke mechanism. J Neurol Sci 358(1–2):371–376. doi:10.1016/j.jns.2015.09.368
Sikkema T, Uyttenboogaart M, van Dijk JM, Groen RJ, Metzemaekers JD, Eshghi O, Mazuri A, Bakker NA, Luijckx GJ (2015) Clinical features and prognosis of intracranial artery dissection. Neurosurgery 76(6):663–670 . doi:10.1227/NEU.0000000000000696discussion 670-661
Jensen-Kondering U, Huhndorf M, Madjidyar J, Jansen O (2015) The subpetrous carotid wall hematoma: a sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography—a retrospective study. RöFo 187(3):168–172. doi:10.1055/s-0034-1385303
Uemura M, Akaiwa Y, Toriyabe M, Mashima T, Terajima K, Shimohata T, Igarashi H, Nakada T, Nishizawa M (2013) Spontaneous middle cerebral artery dissection demonstrated by high-resolution T1-weighted 3D image. Cerebrovasc Dis 36(3):243–244. doi:10.1159/000353873
Kontzialis M, Wasserman BA (2016) Intracranial vessel wall imaging: current applications and clinical implications. Neurovascular Imaging 2 (1). doi:10.1186/s40809-016-0014-5
Kato A, Shinohara Y, Yamashita E, Fujii S, Miyoshi F, Kuya K, Ogawa T (2015) Usefulness of R2* maps generated by iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation sequence for cerebral artery dissection. Neuroradiology 57(9):909–915. doi:10.1007/s00234-015-1549-x
Obusez EC, Hui F, Hajj-Ali RA, Cerejo R, Calabrese LH, Hammad T, Jones SE (2014) High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A3909
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
We declare that all human and animal studies have been approved by our ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
Conflict of interest
We declare that we have no conflict of interest.
Rights and permissions
About this article
Cite this article
Hensler, J., Jensen-Kondering, U., Ulmer, S. et al. Spontaneous dissections of the anterior cerebral artery: a meta-analysis of the literature and three recent cases. Neuroradiology 58, 997–1004 (2016). https://doi.org/10.1007/s00234-016-1731-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-016-1731-9