Non-traumatic anterior cerebral artery dissection with cerebral infarction followed by subarachnoid hemorrhage treated by trapping and bypass: A case report

We report a case of anterior cerebral artery (ACA) dissection presented with cerebral infarction followed by subarachnoid hemorrhage (SAH). A 53-year-old male presenting with headache and weakness of the left lower extremity was admitted to our hospital. Magnetic resonance image showed a localized infarction in the right ACA territory and magnetic resonance angiography revealed an irregularly stenotic lesion, string sign, in the right A2 portion. Conservative therapy including blood pressure control was scheduled, however, SAH occurred on the second day. Cerebral angiography showed aneurysmal dilatation at the right A2. We performed trapping of the ruptured dissection and A3-A3 side-to-side anastomosis emergently. A case of ACA dissection presenting with cerebral infarction followed by SAH is very rare, and we emphasized that trapping and bypass surgery is the most effective to prevent a re-rupture without decreasing peripheral blood flow.