Spontaneous middle cerebral artery dissection: a series of six cases and literature review

Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been rep...

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Bibliographic Details
Published in:Neurosurgical review 2023-09, Vol.46 (1), p.229-229, Article 229
Main Authors: Nounaka, Yohei, Murai, Yasuo, Shirokane, Kazutaka, Matano, Fumihiro, Koketsu, Kenta, Nakae, Ryuta, Watanabe, Akira, Mizunari, Takayuki, Morita, Akio
Format: Article
Language:English
Subjects:
Aged
Angiography
Dissection
Fibrinolytic Agents
Humans
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - surgery
Medicine
Medicine & Public Health
Middle Cerebral Artery - diagnostic imaging
Middle Cerebral Artery - surgery
Neurosurgery
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Summary:Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been reported with no review of the relevant literature. Therefore, we reviewed the relevant literature and our own experience with non-traumatic MCA dissection cases to determine appropriate treatment strategies. At our institution and affiliated institutions, we encountered six cases of MCA dissection—five with infarction and one with hemorrhage. Two patients underwent revascularization, and one underwent an aneurysmectomy. We reviewed English and Japanese articles in PubMed and Medical Journal Web and summarized the results based on the relationships among age, sex, location, the presence of an aneurysm, the presence of angiography, history, treatment, and mode of onset. The clinical course, changes in imaging, treatment strategies, and prognosis were discussed. Eighty cases were included in the review. Cerebral aneurysms were more common distal to the M2 area ( p  = 0.00) and were correlated with hemorrhage ( p  
ISSN:1437-2320
1437-2320
DOI:10.1007/s10143-023-02139-5