A case of a vertebral dissecting aneurysm initially manifesting as ischemic stroke and secondary subarachnoid hemorrhage

Abstract

Cerebral dissecting aneurysms have recently had special remark with the progress of neuroimaging. The causes of presenting neurological symptoms in vertebral artery (VA) dissecting aneurysms are considered mainly to be cerebral ischemia or subarachnoid hemorrhage. It is rare that both cerebral ischemia and subarachnoid hemorrhage occur in a short period. We present a case of a vertebral dissecting aneurysm initially associated with Wallenberg's syndrome caused by ischemic stroke and secondary subarachnoid hemorrhage. The patient was a 57-year-old female with complaints of severe occipitalgia, vertigo and vomiting while swimming. The next day some signs of Wallenberg's syndrome appeared. The patient was referred to our hospital and underwent cerebral angiography, which revealed the dissecting aneurysm originating from the distal side of the right VA - PICA junction. However, she also suffered from severe headache due to subarachnoid hemorrhage after the 11th day from the onset. We performed ligation of the right VA at the distal side of PICA. Repeated cerebral angiograms demonstrated an obstruction of the right VA from the extracranial portion without any signs of neurological deficit. Considering these findings, the orifice of the dissecting aneurysm seemed to be located in the third portion of right VA. Swimming may precipitate the manifestation of symptoms due to VA dissecting aneurysms through minor neck injury.