Subarachnoid Hemorrhage After an Ischemic Attack Due to a Bacterial Middle Cerebral Artery Dissecting Aneurysm: Case Report and Literature Review
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- SAITO Atsushi
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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- KAWAGUCHI Tomohiro
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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- HORI Emiko
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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- KANAMORI Masayuki
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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- NISHIMURA Shinjitsu
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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- SANNOHE Seiya
- Department of Pathology, Aomori Prefectural Central Hospital
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- KAIMORI Mitsuomi
- Department of Pathology, Aomori Prefectural Central Hospital
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- SASAKI Tatsuya
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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- NISHIJIMA Michiharu
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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説明
A 78-year-old woman suffered sudden-onset left hemiparesis. There were no remarkable infectious findings. Computed tomography (CT) demonstrated a low-intensity area supplied by the right middle cerebral artery (MCA). The diagnosis was cerebral ischemia and she was conservatively treated with hyperosmotic fluids. Two days after the ischemic stroke she suddenly became comatose. CT showed diffuse subarachnoid hemorrhage (SAH) in the basal cistern associated with a right intra-Sylvian and a right frontal subcortical hematoma. Three-dimensional (3D)-CT angiography demonstrated occlusion of the M2 portion of the right MCA. Four days after the ischemic onset she died of brain herniation. Autopsy revealed arterial dissection in the intermediate membrane of the right MCA bifurcation and occlusion of the M2 portion of the thrombosed right MCA. Gram staining showed remarkable bacterial infection in the thrombus. SAH after an ischemic attack due to MCA dissection is extremely rare. We suspect that bacterial infection was involved in the formation of her fragile dissecting aneurysm.
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 54 (3), 196-200, 2014
一般社団法人 日本脳神経外科学会