A case of cerebral infarction caused by non-traumatic right anterior cerebral artery dissection-A study for the application of t-PA-

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  • 非外傷性前大脳動脈解離による脳梗塞の１例；ｔ‐ＰＡの適応についての考察

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A 55-year-old woman visited our hospital within one hour of sudden onset of severe pulsatile pain in the front of the head accompanied by limb dominant left hemiplegia. She had previously suffered migraines but had no history of hypertension or cardiac disease. Since brain CT revealed no cerebral hemorrhage, a diagnosis of cerebral infarction was made, and administration of tissue plasminogen activator (tPA) was considered. However, because cerebral arterial dissection could not be excluded, conservative treatment was selected and produced improvement. Consequently, cerebral infarction was detected in the region of the right anterior cerebral artery by brain MRI with no other intracranial vessel abnormalities. After 15 days, stenosis and sacciform dilation on the A2 segment of the right anterior cerebral artery were found and a diagnosis of cerebral infarction caused by cerebral artery dissection was made. Images of cerebral artery dissection are frequently demonstrated by examinations undertaken within 3 months, especially within 2 weeks, and hence complication by subarachnoid hemorrhage due to cerebral artery aneurysm formation occasionally leads to critical results. Thus, in patients with cerebral artery dissection, the time course of imaging examinations is important and the application of t-PA must be carefully considered.

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