Clinical analysis of patients with ischemic stroke from arterial dissection in anterior circulation

초록

Purpose: Arterial dissection in intracranial cerebral arteries are rather rare and occur most frequently in the territory of the vertebrobasilar circulation. The authors experienced four cases of ischemic stroke from arterial dissection in anterior circulation, and investigated neuroradiologic and clinical features. Methods: From January 2011 to December 2015, medical records and radiologic findings of patients diagnosed as cerebral infarction from arterial dissection in anterior circulation were analyzed. Anterior cerebral artery (ACA) dissection was 2 cases, and middle cerebral artery (MCA) and internal carotid artery (ICA) was reported in 1 case respectively. Results: All the patients were in young age or middle-aged with history of hypertension, and the mean age was 39.8 years. All showed cerebral infarction from involved arterial territory, but in one case (ACA dissection) subarachnoid hemorrhage also noticed. Two patients had suffered from severe headache a few days before neurological deficit onset. Arterial dissection was diagnosed from conventional angiography. Antiplatelet drugs were administrated to all the patients with control of blood pressure, and other strategy such as anticoagulation or endovascular stenting not applied. The three patients showed favorable outcomes, and the one neurological deficit. Conclusion: Arterial dissection presenting with cerebral infarction in anterior circulation has several neuroradiologic and clinical characteristics, which suggests that it may be differentiated with that of posterior circulation. Neurosurgeons should understand it as a possible cause of ischemia in middle-aged or young age patients.