1994 年 22 巻 4 号 p. 311-318
During 2.5 years after introduction of MRI, we have experienced 9 cases of vertebral dissecting aneurysm (VDA) that initially appeared with the signs and symptoms of subarachnoid hemorrhage. The patients' age ranged from 40 to 70 years (average: 51.8 years), and 6 male and 3 female patients were included in this series. Five of the 9 patients were hypertensive and 1 had an episode of CVA (internal carotid occlusive disease). It was particularly noteworthy that abducens palsy was observed in varying degrees in 8 cases immediately after the SAH symptoms.
Lower cranial nerve palsy was also observed in 2 elderly cases. On MRI, VDA consistently showed high signal intensity around eccentric signal void. However, the intimal flap and double lumen could not be confirmed. Angiography demonstrated a fusiform dilatation of the vertebral artery with irregular surface on it and either narrowing or tapering in vascular diameter was found adjacent to the dilated portion.
VDA with the onset of SAH was characterized by these MRI and angiographic findings.
In 4 cases, VA was surgically ligated following balloon occlusion test. Coating of VDA was performed in 2 cases while conservative treatment was chosen for 2 cases. The outcome in the 9 month to 2 year follow-up study was good or excellent except for 1 case that resulted in death with a complication of early recurrent hemorrhage within 5 days after its onset. Based on our results in this series, it was considered that vertebral dissection tends to extend to the basilar artery particularly in aged patients with atherosclerosis, and so conservative treatment seems to be preferred for these elderly cases. For relatively younger cases, proximal ligation should be chosen in stable chronic stage, for spontaneous occlusion is not rare in these cases.