Spontaneous Intradural Cerebral Artery Dissection: Spectrum of Clinical Presentations and Correlation with Angiographic Findings
Aminur Rahman1*, Sirintara Pongpech2, Pakorn Jiarakongmun2, Ekachat Chanthanaphak2, Wittawat Takong2, Kittiphop Somboonnithiphol2 and Thanaboon Worakijthamrongchai2
1Assistant Professor, Department of Neurology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
2The Division of Interventional Neuroradiology, Department of Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Thailand
*Corresponding Author: Aminur Rahman, Assistant Professor, Department of Neurology, Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh.
August 23, 2021; Published: September 08, 2021
Aim: Intradural Cerebral Artery dissections are recognized cause of stroke. Aim of this study was to analysis the distribution of spontaneous intradural cerebral artery dissection, angiographic pattern with the symptomatology of admitted patients to our hospital.
Materials and Methods: We analyzed retrospectively collected data of the stroke patients’ and carefully evaluated on 4-vessels angiogram in our institute from January 2013 to June 2014. Out of 164 of cerebral dissections in angiographically evidenced we found only 16 patients of intradural dissecting aneurysms that were included in this study. The male-female ratio was 37.5: 62.5 and the mean age was 47.56 ± 13.19 years. According to the angiographic finding depicting the location of the dissection plane in the arterial wall, we categorized to steno-occlusive, aneurysmal, combined pattern. In each dissection pattern, we evaluated presenting symptoms and presence of subarachnoid hemorrhage, infarction, and intracerebral hemorrhage or combined.
Results: The most common symptomatic presentation was headache (75%), followed by neck pain (50%), motor weakness of limb(s) (43.8%), loss of consciousness (37.5%), vertigo (12.5%), vomiting (12.5) and arm tingling sensation (6.3%). The most common angiographic pattern was aneurysmal patterns (68.75%) followed by steno-occlusive (18.75%) and combined (steno-occlusive and aneurysmal) (12.5%) patterns. aneurysmal pattern was most frequently related to subarachnoid hemorrhage (SAH) (7/11, 63.63%) in contrast that steno-occlusive pattern was only related to infarction (3/3, 100%). The most frequent dissection was in the intradural vertebral arteries (IV) and posterior cerebral artery (PCA), presented with SAH 80% (4/5) and 33.33% (1/3) respectively followed by infarction and intracerebral hemorrhage (ICH). Infarction was common abnormality in patients with the intradural carotid arteries(IC) 33.33%(1/3), superior cerebellar artery(SCA) 33.33%(1/3) and basilar artery(BA) 33.33% (1/3) each but intracerebral hemorrhage(ICH) was common abnormality in patients with the posterior inferior cerebellar artery(PICA) 50%(1/2).
Conclusion: The most common symptomatic clinical presentations of intradural cerebral artery dissection are headache and neck pain followed by motor weakness of limbs and loss of consciousness. SAH with aneurysmal pattern, in the posterior circulation especially in the vertebral artery is the most frequent diagnosis of in intradural cerebral artery dissection which requires combined analysis of angiographic pattern and clinical presentations of stroke.
Keywords: Intradural Cerebral Arteries; Dissection; Aneurysm
- Kim YK and Schulman S. "Cervical artery dissection: pathology, epidemiology and management". Thrombosis Research6 (2009): 810-821.
- Ducrocq X., et al. “Accidents vasculaarescérébrauxischémiques du sujetjeune”. Étude prospective de 296 patients âgés de 16 à 45 ans. Review on Neurology 155 (1999): 575-582.
- Hart RG and Easton JD. “Dissections”. Stroke 16 (1985): 925-927.
- Suzuki K., et al. “Anterior cerebral artery dissection presenting subarachnoid hemorrhage and cerebral infarction”. Journal of Nippon Medical School 2 (2012): 153-158.
- Yamaura A., et al. “Clinical picture of intracranial non-traumatic dissecting aneurysm”. Neuropathology 1 (2000): 85-90.
- Endo S., et al. “A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature”. Neurosurgery 33 (1993): 732-738.
- Amagasa M., et al. “Posttraumatic dissecting aneurysm of the anterior cerebral artery: case report”. Neurosurgery 2 (1988): 221-225.
- Huang YC., et al. “Cervicocranial arterial dissection: experience of 73 patients in a single center”. Surgical Neurology 72 (2009): S20-27; discussion S27.
- Ohkuma H., et al. “Neuroradiologic and clinical features of arterial dissection of the anterior cerebral artery”. AJNR American Journal of Neuroradiology4 (2003): 691-699.
- Suzuki I., et al. “Nontraumatic arterial dissection of the anterior cerebral artery: six cases report”. No To Shinkei. 57.6 (2005): 509-515.
- Krings T and Choi IS. “The many faces of intracranial arterial dissections”. Interventional Neuroradiology 16 (2010): 151-160.
- Shin JH., et al. “Vertebral artery dissection: spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation”. Radiographics 20 (2000): 1687-1696.
- Touzé E., et al. “Aneurysmal forms of cervical artery dissection: associated factors and outcome”. Stroke 32 (2001): 418-423.
- Hart RG and Easton JD. “Dissections of cervical and cerebral arteries”. Neurology Clinics 1 (1983): 155-182.
- Kwak JH., et al. “Cerebral Artery Dissection: Spectrum of Clinical Presentations Related to Angiographic Findings”. Neurointervention2 (2011): 78-83.
- Schievink WI., et al. “Recurrent spontaneous cervical-artery dissection”. The New England Journal of Medicine 330 (1994): 393-397.
- Schievink WI., et al. “Spontaneous dissections of cervicocephalic arteries in childhood and adolescence”. Neurology 44 (1994): 1607-1612.
- Chaves C., et al. “Spontaneous intracranial internal carotid artery dissection”. Archives of Neurology 59 (2002): 977-9811.
- Kocaeli H., et al. “Spontaneous intradural vertebral artery dissection: a single center experience and review of literature”. Skull Base 19 (2009): 209-218.
- Li S., et al. “Prognosis of intracranial dissection relates to site and presenting features”. Journal of Clinical Neuroscience 18 (2011): 789-793.
- Silbert PL., et al. “Headache and neck pain in spontaneous internal carotid and vertebral artery dissections”. Neurology 45 (1995): 1517-1522.
- Bogousslavsky J and Regli F. “Ischemic stroke in adults younger than 30 years of age. Cause and prognosis”. Archives of Neurology 44 (1987): 479-482.
- Lucas C., et al. “Stroke patterns of internal carotid artery dissection in 40 patients”. Stroke 29 (1998): 2646-2648.
- Strong KC. “A study of the structure of the media of the distributing arteries by the method of microdissection”. The Anatomical Record 72 (1938): 151-167.
- Kocaeli H., et al. “Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature”. Skull Base 19 (2009): 209-218.
- Mizutani T., et al. “Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms”. Neurosurgery 45 (1999): 253-259.
- In HS., et al. “Intracranial stenting in patients with atherosclerotic stenosis associated with various aneurysms in the same diseased arterial segment”. AJNR American Journal of Neuroradiology 31 (2010): 1895-1898.
- Yonas H., et al. “Dissecting intracranial aneurysms”. Surgical Neurology 8 (1977): 407-415.
- Yamada SM., et al. “Dissecting aneurysm of the anterior cerebral artery with severe subarachnoid hemorrhage during treatment for cerebral infarction”. Internal Medicine 42 (2003): 433-435.
- Ohkuma H., et al. “Dissecting aneurysms of intracranial carotid circulation”. Stroke 33 (2002): 941-947.
- Mizutani T. “Natural course of intracranial arterial dissections”. Journal of Neurosurgery 114 (2011): 1037-1044.