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Dissecting aneurysm of intracranial vertebral artery: case report and review of literature

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Summary

A spontaneous dissecting aneurysm of the intracranial portion of the dominant right vertebral artery presented as massive subarachnoid hemorrhage, excruciating headache, and respiratory arrest in a 57-year-old white man with a history of systemic hypertension. He died on the 3rd day. Postmortem examination revealed a dissecting hemorrhage extending for 2.1 cm along the artery; rupture of the intima, media, and adventitia could be demonstrated. The intramural accumulation of blood in the proximal segments appeared to be related to retrograde dissection within a media weakened by cystic degeneration. Accumulation of pools of mucoid ground substance was also demonstrated in other intracranial and extracranial arteries. Hemodynamic stresses due to arterial hypertension and physical exertion may have played a contributory role in the etiopathogenesis of this uncommon form of cerebrovascular accident. A comprehensive literature review permits a comparison of supratentorial and infratentorial dissecting aneurysms; vertebral and basilar artery dissections are presented in tabular form.

Zusammenfassung

Ein spontan dissezierendes Aneurysma des intrakraniellen Abschnittes der dominanten rechten A. vertebralis mit massiver Subarachniodalblutung bei einem 57jährigen Mann mit anamnestisch bekannter Hypertonie führte zu starken Kopfschmerzen, Atemstillstand und schließlich am 3. Tag zum Tode. Die Autopsie ergab eine Blutung aus einer 2,1 cm langen Dissekation mit einem Riß durch Intima, Media und Adventitia. Die Blutansammlung im proximalen Abschnitt spricht für eine retrograde Dissekation innerhalb der durch eine zystische Degeneration geschwächten Media. Eine Häufung poolförmiger mucoider Grundsubstanz wurde auch in anderen intraund extrakraniellen Arterien nachgewiesen. Hämodynamischer Streß infolge Hypertonie und körperliche Belastung konnten eine mitbestimmende Rolle in der Ätiopathogenese der ungewöhnlichen Form eines cerebralen Insultes spielen. Ein umfassender Literaturüberblick gestattet eine Vergleich supra- und subtentorieller dissezierender Aneurysmen; diese werden tabellarisch einmal im Bereich der Vertebralarterien, zum anderen im Bereich der A. basilaris dargestellt.

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Authors and Affiliations

  1. Department of Pathology (Neuropathology), Georgetown University Medical Center, 3900 Reservoir Road, N.W., 20007, Washington, D.C., USA

    H. J. Manz

  2. Department of Surgery (Neurosurgery), Georgetown University Medical Center, 3900 Reservoir Road, N.W., 20007, Washington, D.C., USA

    A. J. Luessenhop

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Manz, H.J., Luessenhop, A.J. Dissecting aneurysm of intracranial vertebral artery: case report and review of literature. J Neurol 230, 25–35 (1983). https://doi.org/10.1007/BF00313594

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  • DOI: https://doi.org/10.1007/BF00313594

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