Rapidly progressive dissecting aneurysm on posterior communicating artery

초록

Objective: Dissecting aneurysm of the posterior communicating artery is a rare, but dangerous lesion that carries a high morbidity and mortality rate. The progressive lesion in short period is an extremely rare, and there has been no case report as far the authors know. We present diagnosis and treatment experience of 49-year-old woman with rapidly progressive dissecting aneurysm on posterior communicating artery that was not found on initial angiography. Method: The patient presented with sudden bursting headache, and visited the emergency room. The neurological deficit was not noticed except meningeal irritation sign, and computed tomography revealed thin subarachnoid on basal cisterns. The conventional angiography did not show any intracranial aneurysm or dissection at all. The headache was aggravated although conservative management was done, and follow up angiography was performed nine days later. The fusiform dilatation which was not shown on previous angiography was found on posterior communicating artery. It was diagnosed as a rapidly progressive dissecting aneurysm. Results: The posterior communicating artery was well developed, but posterior cerebral artery was mainly supplied from vertebrobasilar system. The occlusion and damage to the thalamoperforating arteries from posterior communicating artery was the most concerned complication, but the authors the occlusion might be safe because the segment was already injured from dissection. The coil embolization to occlude the dissecting segment was successful without any complication. And the patient discharged without any problem. Conclusion: Subarachnoid hemorrhage with rapidly progressive dissecting aneurysm on posterior communicating artery can be treated with coil embolization without complication.