Abstract
A 57-year-old female presented left-sided weakness, but her deficit improved for a few days. MRI performed a week later after onset showed infarctions in the head of the right caudate nucleus and the cortex of the right frontal lobe. MRI and DSA revealed an irregular dilatation with the pseudolumen in the right ICA C1-2 portion. She was diagnosed with ischemic stroke due to intracranial internal carotid artery dissection. After conservative therapy including Cilostazol and blood pressure control, the size of ICA dissection remained unchanged. However, the follow-up angiography six months after onset revealed aneurysmal dilatation of the C1-2 portion. Therefore, we stopped Cilostazol. An ischemic attack recurred in the subcortex of the right frontal and temporo-parietal lobe seven months after onset. To prevent both the recurrence of ischemic attack and occurrence of subarachinoid hemorrhage due to the rupture of the aneurysm, we planned to trap the dissecting ICA aneurysm with the use of STA-MCA double bypass under motor evoked potential (MEP) monitoring. However, MEP amplitudes decreased during surgery after trapping of the ICA. Therfore, we were obliged to treat the dissecting aneurysm with proximal occlusion to avoid ischemic complication. The postoperative course was uneventful. Motor paresis deteriorated immediately after surgery, but she recovered after 72 hr.
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