Simultaneous dissections of 3 separate cerebral arteries presented with severe headache – A case report

초록

Introduction: The cerebral artery dissection is relatively rare vascular condition, sometimes leading to stroke. We report a case with concurrent dissection of 3 separate cerebral arteries, which presented with severe headache. Case Description: A 39 year-old man had severe headache of sudden onset. Brain MRI and digital subtraction angiography showed multiple dissections with double lumen and intimal flap on both internal cerebral artery and left vertebral artery (figure 1). Subarachnoid hemorrhage or cerebral infarction was not found. Intravenous infusion of nicardipine and hepain started and the blood pressure was controlled below 140/90 mmHg. However, the severity of headache did not improve over three days, in spite of symptomatic control with NSAIDs. Then the carvediol was tried orally by 25mg daily, and the headache dramatically subsided. The pulse pressure was reduced from 60mmHg to 35mmHg after taking carvediol. Discussion and Implication: To our knowledge, this is the first report of dissection in triple cerebral artery. This case also suggested that the beta-blocker might be effective on the relief of headache in cerebral artery dissection. The reduction of pulse pressure by beta blocker was possible mechanism for headache relief