Neuroradiologic and Clinical Features of Arterial Dissection of the Anterior Cerebral Artery
Hiroki Ohkumaa,
Shigeharu Suzukia,
Tomoshige Kikkawaa and
Norihito Shimamuraa
a From the Department of Neurosurgery, Hirosaki University School of Medicine, Hirosaki, Japan
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FIG 1. Representative CT findings in patients presenting with SAH.
A, Diffuse thick SAH in the most subarachnoid cisterns due to bleeding from arterial dissection at A1.
B, Thin localized SAH in the interhemispheric fissure (arrowheads) due to bleeding from arterial dissection at A3.
C, Very thin SAH in the interhemispheric cistern (arrowheads) and in the sulcus of the convexity of the cerebral hemisphere (arrow) due to bleeding from arterial dissection at A2 in the combined group.
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FIG 2. Representative findings of cerebral angiography in the ischemic cases.
A, Lateral view angiogram of the right carotid artery in case 9. Stenosis (arrowheads) with dilation (arrow) at the A2 portion of the ACA.
B, Oblique view angiogram of the left carotid artery in case 13. Stenosis (closed arrowhead) with dilation (open arrowheads) at the A2 portion of the ACA accompanied by an intimal flap (arrow).
C, Oblique view angiogram of the left carotid artery in case 8. Stenosis (closed arrowheads) accompanied by the double lumen sign (open arrowheads).
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FIG 3. Cerebral angiograms of the cases presenting with bleeding from arterial dissection at A1. Slight stenosis (arrowhead) and aneurysmal dilation (arrow) are seen in all cases.
A, Anteroposterior view angiogram of the left carotid artery in case 1.
B, Oblique view angiogram of the right carotid artery in case 3.
C, Oblique view angiogram of the right carotid artery in case 2.
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FIG 4. Representative findings of serial changes of the lesion on cerebral angiograms.
A, Oblique view angiogram of the right carotid artery, obtained at admission, shows mild stenosis accompanied by double lumen (arrowheads) at A2.
B, Oblique view angiogram of the right carotid artery shows progression to severe stenosis (closed arrowheads) with aneurysmal dilation (open arrowhead) 2 weeks after onset.
C, Oblique view angiogram of the right carotid artery shows resolution 5 months after onset (arrowheads).
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FIG 5. Bar graph shows serial changes of the stenotic portion as seen on cerebral angiograms. The changes were analyzed by using the 15 follow-up angiography studies.
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FIG 6. Images from case 12.
A, T1-weighted MR image shows hyperintensity around the signal intensity void.
B, Lateral view angiogram of the left carotid artery, obtained on the same day as the image presented in A, shows stenosis (closed arrowheads) with dilation (open arrowheads).
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FIG 7. Bar graph shows hyperintensity around the signal intensity void, as seen on T1-weighted MR images, considered to be due to intramural hematoma (IMH) based on the timing of the examination.
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FIG 8. Example comparisons of MR angiograms and cerebral angiograms.
A, MR angiogram from case 7 shows stenosis (arrow) in the left ACA.
B, Lateral view angiogram of the left carotid artery shows compatible findings.
C, MR angiogram from case 9 shows stenosis (arrowheads) and dilation (arrow) in the right ACA.
D, Anteroposterior view angiogram of the right carotid artery shows compatible findings.
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FIG 9. CT scans and MR images show infarction in patients presenting with cerebral ischemia.
A, CT scan shows infarction along the interhemispheric fissure (arrow).
B, CT scan shows infarction at the watershed area (arrow).
C, MR image shows multiple patchy infarctions in the ACA territory (arrow).
D, MR image shows patchy infarctions in the ACA territory (arrow).
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AJNR - American Journal of Neuroradiology