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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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| Published in: | Neurosurgical review 2023-09, Vol.46 (1), p.229-229, Article 229 |
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| container_title | Neurosurgical review |
| container_volume | 46 |
| creator | Nounaka, Yohei Murai, Yasuo Shirokane, Kazutaka Matano, Fumihiro Koketsu, Kenta Nakae, Ryuta Watanabe, Akira Mizunari, Takayuki Morita, Akio |
| description | 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
|
| doi_str_mv | 10.1007/s10143-023-02139-5 |
| format | article |
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p
= 0.00) and were correlated with hemorrhage (
p
< 0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.
Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed up, and antithrombotic treatment should be considered with particular care in older adults.</description><identifier>ISSN: 1437-2320</identifier><identifier>EISSN: 1437-2320</identifier><identifier>DOI: 10.1007/s10143-023-02139-5</identifier><identifier>PMID: 37676338</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Neurosurgical review, 2023-09, Vol.46 (1), p.229-229, Article 229</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-135e38cff18eea913a51c340cd4f9ca75ead1f7b0716ee77a15b67bf5af7080f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37676338$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nounaka, Yohei</creatorcontrib><creatorcontrib>Murai, Yasuo</creatorcontrib><creatorcontrib>Shirokane, Kazutaka</creatorcontrib><creatorcontrib>Matano, Fumihiro</creatorcontrib><creatorcontrib>Koketsu, Kenta</creatorcontrib><creatorcontrib>Nakae, Ryuta</creatorcontrib><creatorcontrib>Watanabe, Akira</creatorcontrib><creatorcontrib>Mizunari, Takayuki</creatorcontrib><creatorcontrib>Morita, Akio</creatorcontrib><title>Spontaneous middle cerebral artery dissection: a series of six cases and literature review</title><title>Neurosurgical review</title><addtitle>Neurosurg Rev</addtitle><addtitle>Neurosurg Rev</addtitle><description>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
< 0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.
Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed up, and antithrombotic treatment should be considered with particular care in older adults.</description><subject>Aged</subject><subject>Angiography</subject><subject>Dissection</subject><subject>Fibrinolytic Agents</subject><subject>Humans</subject><subject>Intracranial Aneurysm - diagnostic imaging</subject><subject>Intracranial Aneurysm - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Cerebral Artery - diagnostic imaging</subject><subject>Middle Cerebral Artery - surgery</subject><subject>Neurosurgery</subject><issn>1437-2320</issn><issn>1437-2320</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kD1PwzAQhi0EouXjDzAgjywBO27imA1VfEmVGICFxXKcM3KVj-JLgP57XFIQE4Nl3_m5V7qHkBPOzjlj8gI54zORsHRzuFBJtkOmsSOTVKRs9897Qg4Ql4xxqRjfJxMhc5kLUUzJy-Oqa3vTQjcgbXxV1UAtBCiDqakJPYQ1rTwi2N537SU1FCF4QNo5iv6TWoOxMG1Fax9h0w8BaIB3Dx9HZM-ZGuF4ex-S55vrp_ldsni4vZ9fLRKbqqJPuMhAFNY5XgAYxYXJuBUzZquZU9bIDEzFnSyZ5DmAlIZnZS5LlxknWcGcOCRnY-4qdG8DYK8bjxbqetxKp0WeciVVoSKajqgNHWIAp1fBNyasNWd641SPTnV0qr-d6iwOnW7zh7KB6nfkR2IExAhg_GpfIehlN4Q27vxf7BcB8YM7</recordid><startdate>20230907</startdate><enddate>20230907</enddate><creator>Nounaka, Yohei</creator><creator>Murai, Yasuo</creator><creator>Shirokane, Kazutaka</creator><creator>Matano, Fumihiro</creator><creator>Koketsu, Kenta</creator><creator>Nakae, Ryuta</creator><creator>Watanabe, Akira</creator><creator>Mizunari, Takayuki</creator><creator>Morita, Akio</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20230907</creationdate><title>Spontaneous middle cerebral artery dissection: a series of six cases and literature review</title><author>Nounaka, Yohei ; Murai, Yasuo ; Shirokane, Kazutaka ; Matano, Fumihiro ; Koketsu, Kenta ; Nakae, Ryuta ; Watanabe, Akira ; Mizunari, Takayuki ; Morita, Akio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-135e38cff18eea913a51c340cd4f9ca75ead1f7b0716ee77a15b67bf5af7080f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Angiography</topic><topic>Dissection</topic><topic>Fibrinolytic Agents</topic><topic>Humans</topic><topic>Intracranial Aneurysm - diagnostic imaging</topic><topic>Intracranial Aneurysm - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Cerebral Artery - diagnostic imaging</topic><topic>Middle Cerebral Artery - surgery</topic><topic>Neurosurgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nounaka, Yohei</creatorcontrib><creatorcontrib>Murai, Yasuo</creatorcontrib><creatorcontrib>Shirokane, Kazutaka</creatorcontrib><creatorcontrib>Matano, Fumihiro</creatorcontrib><creatorcontrib>Koketsu, Kenta</creatorcontrib><creatorcontrib>Nakae, Ryuta</creatorcontrib><creatorcontrib>Watanabe, Akira</creatorcontrib><creatorcontrib>Mizunari, Takayuki</creatorcontrib><creatorcontrib>Morita, Akio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgical review</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nounaka, Yohei</au><au>Murai, Yasuo</au><au>Shirokane, Kazutaka</au><au>Matano, Fumihiro</au><au>Koketsu, Kenta</au><au>Nakae, Ryuta</au><au>Watanabe, Akira</au><au>Mizunari, Takayuki</au><au>Morita, Akio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spontaneous middle cerebral artery dissection: a series of six cases and literature review</atitle><jtitle>Neurosurgical review</jtitle><stitle>Neurosurg Rev</stitle><addtitle>Neurosurg Rev</addtitle><date>2023-09-07</date><risdate>2023</risdate><volume>46</volume><issue>1</issue><spage>229</spage><epage>229</epage><pages>229-229</pages><artnum>229</artnum><issn>1437-2320</issn><eissn>1437-2320</eissn><abstract>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
< 0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.
Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed up, and antithrombotic treatment should be considered with particular care in older adults.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37676338</pmid><doi>10.1007/s10143-023-02139-5</doi><tpages>1</tpages></addata></record> |
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| 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 |
| title | Spontaneous middle cerebral artery dissection: a series of six cases and literature review |
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