Middle Cerebral Artery Dissection Research Articles

A Pediatric Case of Middle Cerebral Artery Dissection With Delayed Morphological Changes

A Pediatric Case of Middle Cerebral Artery Dissection With Delayed Morphological Changes

Various treatment modalities for isolated intracranial middle cerebral arterial dissection with progressive ischemic symptoms: 2 case reports of endovascular stent and bypass surgery.

Isolated middle cerebral artery dissection (MCAD) is rare but increasingly recognized as a significant clinical entity, particularly in younger adults. Ischemic stroke is the most common manifestation in symptomatic cases but symptoms can vary in severity from headaches to severe neurologic deficits. Due to its rarity and unpredictable clinical course, there is no established treatment strategy for isolated MCAD. Through two case reports, we reviewed the post-operative clinical course of MCAD under different treatment modalities. Case 1 was a 21-year-old woman who presented to the emergency department with headaches and left-side hemiparesis. Isolated MCAD was diagnosed and she was successfully treated with the placement of a self-expandable stent and subsequent chemical angioplasty for post-stent vasospasm. Case 2 was a 35-year-old woman who presented to the emergency department with left-side hemiparesis and dysarthria. Isolated MCAD was diagnosed and she was successfully treated with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis.

Endovascular treatment of distal middle cerebral artery dissecting aneurysm with intracerebral hemorrhage in a paediatric patient: a case report and literature review

BackgroundIntracranial arterial aneurysms in the paediatric age group constitute less than 5% of all aneurysms. The most common form is spontaneous dissecting aneurysms (SDAs) (Peron et al. in Acta Neurochir 152(9):1511–1517, 2010; Huang et al. in Surg Neurol 63(5):424–432, 2005; Krishna et al. in Acta Neurochir 147(5):469–476, 2005; Ihn and Jung in J Korean Soc Radiol 65(5):441–445, 2011). It occurs most commonly in the posterior circulation and rarely in the anterior circulation, including the middle cerebral artery (MCA) (Chuang et al. in Asian J Surg 35(1):42–48, 2012; Ozaki et al. in World Neurosurg 113:208–211, 2018). MCA dissecting aneurysm even rarely presents with intracerebral haemorrhage (Ete et al. in J Case Rep 3(2):451–454, 2013; Ahmad in Interdiscip Neurosurg 18:100510, 2019; Bartoš et al. in Brain Sci 11(1):29, 2020).Case descriptionA 12 years old non-diabetic, non-hypertensive female presented with distal right MCA (M2-M3 junction) dissecting aneurysm with right parieto-temporal haemorrhage. The patient was well managed with endovascular coil embolization with a good functional outcome.ConclusionEndovascular coil embolization had favourable clinical and angiographic outcomes in distal MCA dissecting aneurysms.

Middle Cerebral Artery Dissection: A Report of Two Cases With Treatments and Outcomes

In the present report, we describe two cases of right-sided M1 segment middle cerebral artery dissection in a 51-year-old Asian female and in a 28-year-old Caucasian male patient with no previous history of ischemic stroke or known intracranial atherosclerosis presenting with acute unilateral headache progressing to severe multifocal hemispheric infarction with nearly complete one-sided motor paralysis. In both patients, a middle cerebral artery dissection was detected on angiography; they were given exclusively medical therapy: patient 1 was not eligible to reperfusive therapies and was treated with a three-month course of acetylsalicylic acid and clopidogrel combined with low-dose enoxaparin, while patient 2 was initially treated with intravenous alteplase with no hemorrhagic complications and was later shifted to single antiplatelet therapy. Despite an initial worsening of clinical severity and an extensive ischemic lesion in both patients, neurologic function improved over time, eventually allowing recovery of unaided gait. Therefore, in the absence of signs of hemorrhage, intravenous thrombolysis or dual antiplatelet regimens could be considered in strokes related to middle cerebral artery dissection.

Intracranial Fibromuscular Dysplasia in a Male Child Presented by Middle Cerebral Artery Dissection and Stroke

Fibromuscular dysplasia (FMD) is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries it typically occurs in women aged between 30 and 50 years. FMD in children is rare and its most common site of involvement are renal arteries. Stroke in children is generally uncommon and due to FMD is even rarer, which is why it is often unrecognized. We present a case of a boy, with an inconspicuous previous anamnesis and orderly development, who woke up at the age of 9 with weakness of the left side of the body and speech disorders. MR showed an ischemic lesion in the irrigation area of the right middle cerebral artery (arteria cerebri media- ACM). In neurological status mild dysarthria with left central facial nerve lesion was noted as well as mild paresis of the left extremities. Neurosonological testing showed segmental extensions and narrowing of the right ACM with underlying dissection, which speaks in favour of fibromuscular dysplasia. Therapy with acetylsalicylic acid 50 mg was initiated, and with further follow-up of the patient, complete regression of symptoms and normal neurological status were recorded.

Childhood Primary Angiitis of the Central Nervous System Presenting as Isolated Middle Cerebral Artery Dissection

Isolated middle cerebral artery dissection and primary angiitis of the central nervous system are two rare but serious causes of ischemic stroke in children. We report a case of a patient who presented with headache, left-sided hemiparesis, and left hemi-hypoesthesia with acute cerebral infarction in the right middle cerebral artery territory. Brain magnetic resonance imaging showed isolated right middle cerebral artery dissection with arterial wall contrast enhancement extending beyond the length of the dissection and diffuse narrowing with stenosis in the right posterior cerebral artery suggesting angiitis. After exclusion of other diagnoses the patient was treated with corticosteroids and dual antiplatelet therapy. Follow up magnetic resonance imaging performed 4 months later showed partially improved contrast enhancement in the right middle cerebral artery and persistent narrowing and focal stenosis of the right posterior cerebral artery. Although rare, primary angiitis of the central nervous system should be considered in the differential diagnosis of acute stroke in children. High-resolution vessel wall imaging magnetic resonance studies can provide important information in determining the etiology of stroke.

A Case of Middle Cerebral Artery Dissection Suspected Association with Blunt Head Trauma

A Case of Middle Cerebral Artery Dissection Suspected Association with Blunt Head Trauma

Endovascular Approach in Patients with Acute Complete Occlusion Due to Middle Cerebral Artery Dissection.

ObjectiveDissection of the middle cerebral artery (MCA) is less common than dissection of vessels in the vertebrobasilar system or carotid artery. Acute complete occlusion related to MCA dissection is extremely rare. We report an endovascular approach in patients with acute complete occlusion due to MCA dissection. MethodsWe reviewed retrospectively the endovascular procedure and clinical results for acute-stroke patients who underwent recanalization from October 2014 through December 2018. Initial imaging findings and the endovascular procedure were analyzed for patients with acute complete occlusion due to MCA dissection. ResultsWe undertook first-line aspiration thrombectomy using a Penumbra catheter in 294 patients with acute occlusion of the M1 segment. Of these patients, seven were confirmed to have acute complete occlusion due to MCA dissection. All patients had angiographic findings of an intimal flap at the proximal occlusion site of the MCA. One patient complained of severe headache during microcatheter passage through the occluded lesion and died due to massive bleeding caused by rupture of the false lumen. The remaining patients underwent initial contact aspiration thrombectomy without microcatheter passage. After aspiration thrombectomy, six patients had delayed flow through the MCA. One patient underwent stenting of the MCA because of progressive symptoms. ConclusionAn intimal flap at the proximal portion of an occluded MCA can suggest the possibility of MCA dissection. Contrast aspiration thrombectomy without microcatheter passage can reduce the risk of false lumen rupture in cases of MCA dissection.

Intraarterial therapy for middle cerebral artery dissection with intramural hematoma detection on susceptibility-weighted imaging

Intraarterial therapy for middle cerebral artery dissection with intramural hematoma detection on susceptibility-weighted imaging

Acute hemichorea with T1 ischemic hyperintensity associated with steno‐occlusive middle cerebral artery dissection

AbstractAcute hemichorea with accompanying T1 hyperintensity on magnetic resonance imaging has never been reported in steno‐occlusive middle cerebral artery (MCA) dissection. This characteristic radiological finding which differs from known ischemic changes has been attributed to incomplete infarction with selective neuronal loss. Arguments have also shuttled between gemistocytic astrocyte accumulation, tissue calcification, and paramagnetic substance deposition. We report an unusual case of acute hemichorea caused by proximal MCA dissection with characteristic imaging appearance of delayed ischemic hyperintensity.

A case of Marfan syndrome with ischemic stroke due to middle cerebral artery dissection

AbstractMarfan syndrome is known to cause aneurysm and dissection of the aorta and cerebral artery. Although there are many reports of dissection of the aorta, there are few of intracranial artery dissection. We report a 32‐year‐old man with Marfan syndrome. He was presented to our hospital with sudden left hemiparesis and dysarthria. The initial diffusion‐weighted image revealed high‐intensity lesions in the right corona radiata. Magnetic resonance angiography revealed the disruption of the blood flow signal in the proximal M1 portion of the right middle cerebral artery. The clinical course of acute occlusion and gradual recanalization was confirmed, and we diagnosed the dissection of the right middle cerebral artery. Anticoagulant therapy was started, and the neurological symptoms disappeared about 1 week after the onset. In Marfan syndrome, dissection of the intracranial cerebral artery is rare, so further investigation is required.

Capsular warning syndrome as a manifestation of isolated middle cerebral artery dissection in a Latin American patient

Capsular warning syndrome as a manifestation of isolated middle cerebral artery dissection in a Latin American patient

P4-5 - Successful Intra-arterial Stent Thrombectomy in acute infarction caused by spontaneous middle cerebral artery dissection

P4-5 - Successful Intra-arterial Stent Thrombectomy in acute infarction caused by spontaneous middle cerebral artery dissection

Middle cerebral artery dissection causing subarachnoid hemorrhage and cerebral infarction: Trapping with high-flow bypass preserving the lenticulostriate artery

Background:Spontaneous intracranial arterial dissection (IAD) is an increasingly important cause of stroke, such as subarachnoid hemorrhage (SAH) and hemodynamic or thromboembolic cerebral ischemia. IAD usually occurs in the posterior circulation, and is relatively rare in the anterior circulation including the middle cerebral artery (MCA). Various surgical and endovascular methods to reduce blood flow in the dissected lesion have been proposed, but no optimum treatment has been established.Case Description:An 80-year-old woman with dissection in the M1 portion of the MCA manifesting as SAH presented with repeated hemorrhage and cerebral infarction in the area of the inferior trunk of the MCA. High-flow bypass to the MCA was performed and the dissecting lesion was trapped. Prevention of repeated hemorrhage was achieved, and blood flow was preserved to the lenticulostriate artery as well as the MCA area distal to the lesion.Conclusions:Treatment strategy for IAD of the MCA should be planned for each patient and condition, and surgery should be performed promptly to prevent critical rebleeding given the high recurrence rate. In addition, preventing re-rupture of the IAD, and preserving important perforators around the lesion and blood flow distal to the dissection should be targeted by the treatment strategy.

Wingspan stentの使用経験と文献レビュー

We report three cases that involved the use of the Wingspan stent (WS) system for the treatment of intracranial atherosclerotic disease and review the literature. The first patient was an 80-year-old man who presented with recurrence of a transient ischemic attack and medically refractory restenosis of the left petrous internal carotid artery (ICA). He underwent percutaneous transluminal angioplasty (PTA) and stenting using the WS. There have been no ischemic events and no restenosis after treatment. The second patient was a 73-year-old man who presented with minor stroke due to chronic total occlusion of the left ICA. He underwent PTA and stenting using the WS for dissection of the left ICA. There have been no ischemic events and no restenosis after treatment. The third patient was a 65-year-old woman who presented with minor stroke due to stenosis of the right middle cerebral artery (MCA). She underwent PTA and stenting using the WS for dissection of the right MCA. There have been no ischemic events and no restenosis after treatment. The WS system was useful for the treatment of medically refractory restenosis and dissection of intracranial arteries after PTA.The 1-year risk of recurrence of ischemic stroke in the treatment of symptomatic intracranial arterial stenosis (ICAS) with the WS system was lower than that in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. However, the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial demonstrated that aggressive medical treatment was superior to stenting with the WS system in preventing recurrent ischemic stroke. Further evaluation of clinical outcome is required to confirm the safety and efficacy of the WS system for symptomatic ICAS.

Successful Intra-arterial Stent Thrombectomy in Acute Infarction Caused by Spontaneous Middle Cerebral Artery Dissection

Successful Intra-arterial Stent Thrombectomy in Acute Infarction Caused by Spontaneous Middle Cerebral Artery Dissection

The clinical and imaging features of 118 patients with spontaneous cerebral arterial dissections presenting with ischemic stroke

To investigate the clinical and radiologic features of patients with spontaneous cerebral arterial dissections (CADs) presenting with ischemic stroke and to explore the effect of gender and age on those features. Patients admitted to our stroke center diagnosed as ischemic stroke secondary to CADs from August 2008 to April 2015 were prospectively registered. Patients aged between 15 to 80 years old, who had acute brain infarcts within the territory of a major cerebral artery affected by a dissection confirmed by the neuroradiological examinations, were enrolled in the study. The followings were the exclusion criteria: (1) there were any potential causes for the brain infarcts other than CADs; (2) CADs were the results of a definite cause; (3) the clinical data were incomplete. A total of 118 patients were enrolled in the study with the mean age of (44.2±12.8) years old. There were 87 men (73.7%) and 67 patients (56.8%) aged under 45 years old. Smoking (41.5%), hypertension (25.4%) and hypercholesterolemia (21.2%) were the three leading risk factors for stroke. Hypercholesterolemia was more common in the male patients (25.3% vs 9.7%, P=0.021), whereas hypertension (39.2% vs 14.9%, P=0.005) and diabetes (25.5% vs 4.5%, P=0.002) were more common in the patients aged 45 years or older. Headache or neck pain before or at the onset of stroke was more common in the female patients (67.7% vs 34.5%, P=0.002). A total of 71 patients were found with CADs of the anterior circulation, while 47 patients with that of the posterior circulation. The involvement of the intra and extracranial arteries were documented in 59 and 59 patients, respectively. The middle cerebral artery (MCA) was the most common site in the intracranial dissection and more MCA dissections were observed in the male patients (46.3% vs 11.1%, P=0.016). The dissection of intracranial carotid artery was more common in patients aged under 45 years old (38.7% vs 0, P<0.001). Lumen status of CADs often presented as stenosis (43.2%) and occlusion (41.2%), while less aneurysm (5.9%) and aneurysm with stenosis (9.3%) were observed. Aneurysm was found to be more common in patients aged 45 years or older (11.8% vs 1.5%, P=0.042). Chinese patients with spontaneous CADs presenting with ischemic stroke have unique clinical and imaging features, which correlated with age and gender.

Spontaneous Middle Cerebral Artery Dissection with Distal Internal Carotid Artery Involvement Confirmed by High-Resolution MRI

허혈성 뇌졸중의 원인 중 동맥박리는 흔히 발견되지는 않지 만, 비교적 청장년층에 발생하는 뇌졸중의 주요 원인으로 알 려져 있다. 주로 경추부 내경동맥이나 척추동맥에 발생하며, 두개내 동맥에 국한된 동맥박리는 매우 드물게 관찰된다. 특 히 두개내 동맥박리 중 전순환영역 동맥박리는 후순환영역에 비해 더욱 드물게 관찰되며, 이전 문헌들에 의하면 상상돌기 분절(supraclinoid segment) 내경동맥과 중대뇌동맥의 시작 부 위에 주로 발생하는 것으로 알려져 있다. 또한 전순환영역 두 개내 동맥박리 중 중대뇌동맥박리는 단독으로 발생하기도 하 지만, 내경동맥박리와 동반되어 관찰되기도 한다. 두개내 동 맥박리는 컴퓨터단층혈관조영술, 자기공명영상 및 자기공명 혈관조영술로 진단할 수 있으나, 고식적인 뇌영상기법을 통한 진단은 동맥박리의 위치와 침범 범위를 정확하게 파악하는데 제한적이다. 저자들은 중대뇌동맥박리가 의심되는 환자에서 고해상도 자기공명영상(high-resolution MRI)을 통한 내경동맥 박리의 동반을 확인하였기에 보고하는 바이다.

Symptomatic Isolated Middle Cerebral Artery Dissection: High Resolution MR Findings

Symptomatic Isolated Middle Cerebral Artery Dissection: High Resolution MR Findings

Evolution of a chronic dissecting aneurysm on magnetic resonance imaging in a pediatric patient.

Clinical and imaging manifestations of the so-called partially thrombosed aneurysm (PTA) are different from those of the classic intracranial saccular aneurysm. Given some of their peculiar imaging features, it had been hypothesized that some PTAs occur due to repeated intramural hemorrhages. The authors present a case of PTA that evolved from an acute dissecting aneurysm as shown by serial imaging. A previously healthy 5-year-old boy had a sudden onset of left hemiparesis. Initial MRI sequences showed a perforating vessel infarction in the right basal ganglia area secondary to an acute distal middle cerebral artery (MCA) dissection as demonstrated on conventional angiography. Conservative management with close observation of this dissection was chosen, and serial MRI studies revealed layering of blood of various ages within the wall of an aneurysmal outpouching of the MCA, thereby leading to the imaging appearance of a PTA. The findings in this case indicate that some PTAs may be caused by repeated or chronic dissections, with blood entering the wall through an endothelial defect. Understanding the pathological mechanism underlying the formation of these aneurysms will help inform appropriate treatment strategies.