Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of anterior cerebral artery dissection causing hemorrhagic infarction

Masahiro Oomura, M.D.1), Tadashi Terai, M.D.1), Koji Shigeno, M.D.1) and Takemori Yamawaki, M.D.2)

1)Department of Neurology, Shizuoka Municipal Shimizu Hospital
2)Department of Neurology and Neuroscience, Nagoya City University

A 56-year-old man presented with weakness in his right arm and leg. Throbbing headache occurred several hours prior to his weakness. Brain CT obtained on day 3 demonstrated low density areas in the medial part of the left frontal lobe. Cerebral angiography on day 14 demonstrated dilatation and narrowing of the left anterior cerebral artery (ACA) corresponding to "pearl and string sign". The diagnosis of spontaneous ACA dissection was established with clinical features, laboratory findings, and angiographic findings. Antiplatelet therapy was undertaken for the prevention of ischemic events. Serial Brain CT demonstrated hemorrhagic change in the area of infarction. However, there was no definite clinical deterioration. Antiplatelet therapy was withdrawn after hemorrhagic change was noted. Cerebral angiography on day 35 showed improvement of both dilatation and narrowing. Possible reperfusion injury caused by absorption of intramural hematoma seems to be responsible for hemorrhagic change. In patients with cerebral infarction due to dissection of intracranial arteries, antithrombotic therapy is controversial as hemorrhagic complications including hemorrhagic infarction as well as subarachnoidal hemorrhage can occur. Further accumulation of cases is required.

(CLINICA NEUROL, 45: 41|44, 2005)
key words: cerebral infarction, arterial dissection, anterior cerebral artery, hemorrhagic infarction

(Received: 24-Mar-04)