Aneurismas dissecantes intracranianos da circulação posterior relato de três casos e revisão da literatura

Diniz-Carneiro, Denise S.; Portela, L. A. P.; Melo-Souza, S. E. de

doi:10.1590/S0004-282X1992000300015

Resumos

As dissecções dos vasos cerebrais é causa rara de acidente vascular cerebral (quarta causa). Geralmente são de aparecimento espontâneo ou após trauma simples. É mais comprometido o sistema carotídeo e a evolução costuma ser benigna. As dissecções do sistema vértebro-basilar são menos comuns e a dissecção primária da artéria basilar é rara. As dissecções da circulação posterior têm sido diagnosticadas em proporção crescente, porém, seus mecanismos de lesão, o quadro clínico, os critérios de diagnóstico e o tratamento constituem problema da prática neurológica e a taxa de morbidade e mortalidade ainda é alta. Os autores abordam estes problemas e sugerem medidas que possam ser úteis no manuseio dessa patologia. Descrevem-se três casos de dissecção, dois da artéria vertebral e um da artéria basilar. É feito também levantamento de 80 casos já publicados, comparando-os aos três casos descritos.

sistema vértebro-basilar; aneurisma dissecante; acidente vascular encefálico; hemorragia subaracnóidea

Dissecting aneurysms of cerebral arteries are unusual causes of stroke. The carotid system is the commonest site of this pathology, the vertebral arteries are less involved and dissection of the basilar artery is tfare. The authors report three cases of arterial dissection of the vertebrobasilar system, two of the vertebral arteries and one of the basilar artery. An extensive review of the literature is presented. The clinical picture of dissection of vertebrobasilar system was inespecific but pain was a prominente symptom, though had not occurred in the site of the arteries involved. The pain was suggestive of subarachnoid hemorrhage. Associated or risk factors were mild trauma, migraine and high blood pressure. The angiographic findings were suggestive, however just the «double lumen» has been considered pathognomonic. The prognosis is variable. It was benign in case 3, left sequela in case 2, and case 1 rebleed fatally.

vertebrobasilar system; dissecting aneurysm; stroke; subarachnoid hemorrhage

Dissecting aneurysms of the vertebrobasilar system: report of three cases and review of the literature

Denise S. Diniz-Carneiro^I; L. A. P. Portela^II; S. E. de Melo-Souza^III

^IMédica Residente em Neurologia. Instituto de Neurologia de Goiânia (ING)

^IIRadiologista. Instituto de Neurologia de Goiânia (ING)

^IIINeurologista e Coordenador de Ensino e Pesquisa. Instituto de Neurologia de Goiânia (ING)

RESUMO

As dissecções dos vasos cerebrais é causa rara de acidente vascular cerebral (quarta causa). Geralmente são de aparecimento espontâneo ou após trauma simples. É mais comprometido o sistema carotídeo e a evolução costuma ser benigna. As dissecções do sistema vértebro-basilar são menos comuns e a dissecção primária da artéria basilar é rara. As dissecções da circulação posterior têm sido diagnosticadas em proporção crescente, porém, seus mecanismos de lesão, o quadro clínico, os critérios de diagnóstico e o tratamento constituem problema da prática neurológica e a taxa de morbidade e mortalidade ainda é alta. Os autores abordam estes problemas e sugerem medidas que possam ser úteis no manuseio dessa patologia. Descrevem-se três casos de dissecção, dois da artéria vertebral e um da artéria basilar. É feito também levantamento de 80 casos já publicados, comparando-os aos três casos descritos.

Palavras-chave: sistema vértebro-basilar, aneurisma dissecante, acidente vascular encefálico, hemorragia subaracnóidea.

SUMMARY

Dissecting aneurysms of cerebral arteries are unusual causes of stroke. The carotid system is the commonest site of this pathology, the vertebral arteries are less involved and dissection of the basilar artery is tfare. The authors report three cases of arterial dissection of the vertebrobasilar system, two of the vertebral arteries and one of the basilar artery. An extensive review of the literature is presented. The clinical picture of dissection of vertebrobasilar system was inespecific but pain was a prominente symptom, though had not occurred in the site of the arteries involved. The pain was suggestive of subarachnoid hemorrhage. Associated or risk factors were mild trauma, migraine and high blood pressure. The angiographic findings were suggestive, however just the «double lumen» has been considered pathognomonic. The prognosis is variable. It was benign in case 3, left sequela in case 2, and case 1 rebleed fatally.

Key words: vertebrobasilar system, dissecting aneurysm, stroke, subarachnoid hemorrhage.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. Sebastião Eurico de Melo Souza Instituto de Neurologia de Goiânia - Praça T-18, nº140 -Setor Bueno - 74610 Goiânia GO - Brasil.

1. Akira Y. Diagnosis and treatment of vertebral aneurysms. J Neurosurg 1988, 69:345-349.
2. Alexander CB, Burger PC, Goree JA. Dissecting aneurysms of the basilar artery in 2 patients. Stroke 1979, 10:294-298.
3. Berger MS, Wilson CG. Intracranial dissecting aneurysms of the posterior circulation: report of six cases and review of the literature. J Neurosurg 1984, 61 : 882-894.
4. Bladin PF. Dissecting aneurysm of carotid and vertebrbal arteries. Vasc Surg 1974, 8:202-223.
5. Bogousslavsky J, Despland P, Regli F. Spontaneous carotid dissection with acute stroke. Arch Neurol 1987, 44:137-140.
6. Brilhaye J, Retif J, Jeanmart L, Flament-Duran DJ. Occlusion of the basilar artery in young patients. Acta Neurochirurg 1971, 25:225-229.
7. Caplan R. Migraine and vertebrobasilar ischemia. Neurology 41:55-61.
8. Chapleau CE, Robertson JT. Spontaneous cervical artery dissection: outpatient treatment with continuous heparin infusion using a totally implantable infusion device. Neurosurgery 1981, 8:83-87.
9. Farrel MA, Gilbert JJ, Kaufmann JCE. Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psichiatry 1985, 48:111-121.
10. Fisher CM. The headache and pain of spontaneous carotid dissection. Headache 1982, 22:60-65.
11. Friedman AH, Drake CG. Subarachnoid hemorrhage from intracranial dissecting aneurysms. J Neurosurg 1984, 60 : 325-334.
12. Garcia-Merino JA, Gutierrez JA, Lopes-Lozano JJ, Marqueza M, Lopez F, Liano H. Double lumen dissecting aneurysms of the internal carotid artery in fibromuscular dysplasia: case report. Stroke 1983, 14:815-818.
13. Gauthier G, Rohr J, Wild E. L'hématome dissequant de l'artère carotide interne: revue générale de 205 cas publiés dont dix personnels. Schw Arch Neurol Neurochir Psycriatry 1985, 136:53-74.
14. Hart RG, Easton JD. Dissections of cervical and cerebral arteries. Neurologic Clinics (Symposium on Cerebrovascular Disease) 1983, 1:155-182.
15. Hegedus K. Reticular fiber deficiency in the intracranial arteries of patients with dissecting aneurysm and review of the possible pathogenesis of previously reported cases. Eur Arch Psychiat Neurol Sci 1985, 235:102-106.
16. Hcchberg FH, Bean C, Fisher CM, Roberson GH. Stroke in a 15-year-old girl secondary to terminal carotid dissection. Neurology 1975, 25:725-729.
17. Hugenholtz H, Polrupa R, Montpetit VJA, Nelson R, Richard MT. Spontaneous dissecting aneurysm of the extracranial vertebral artery. Neurosurgery 1982, 10:96-100.
18. Kunze ST, Schiefer W. Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery. Neuroradiology 1971, 2:201-206.
19. Manz HJ, Messenhop AP. Dissecting aneurysm of intracranial vertebral artery: case report and review of literature. J Neurol 1983, 230:25-35.
20. Masanori Y, Kenzo T, Takefumi M, Kazuhiko S. Cerebral dissecting aneurysms in patients with moya-moya disease: report of two cases. J Neurosurg 1983, 58:120-125.
21. Schellas KP, Latchaw RE, Wendling L, Gold HA. Vertebrobasilar injuries following cervical manipulation. Jama 1980, 244:1450-1453.
22. Schinichiro M, Akira Y, Keniehi K, Hiromi F. A dissecting aneurysm of the vertebral artery. Surg Neurol 1984, 21:171-174.
23. Senter HJ, Sazwaz M. Nontraumatic dissecting aneurysms of the vertebral artery: case report. J Neurosurg 1982, 56:128-130.
24. Shiro W, Kiyoshige F, Yoshito M. Dissecting aneurysm of the vertebral artery. Surg Neurol 1978, 10:237-139.
25. Sinclair W Jr. Dissecting aneurysm of the middle cerebral artery associated with migraine syndrome. Am J Pathol 1953, 29:1083-1091.
26. Takeyoshi S, Kuniaki B, Keiji N, Kazufumi I. Dissecting aneurysm of the vertebral artery: report of seven cases and angiographic findings. J Neurosurg 1984, 61:1038-1046.
27. Tomokiro M, Goldberg HI, Parr J, Harper C, Thompson CJ. Cerebral dissecting aneurysm and intimai fibro-elastic thickening of cerebrall arteries: case report. J Neurosurg 1982, 56:571-576.
28. Turnbull HM. Alterations in arterial structures, and their relation to syphilis. Q J Med 1915, 8:201-254.
29. Waga S, Fujimoto K, Morooka Y. Dissecting aneurysm of the vertebral artery. Surg Neurol 1978, 10:237-239.
30. Watson AJ. Dissecting aneurysm of arteries other than the aorta. J Pathol Bacteriol 1956, 72:439-449.
31. West EET, Davies RJ, Kelly RE. Horner's syndrome and headache due to carotid artery disease. Br Med J 1976, 1:818-820.
32. Yonas H, Agamanolis D, Yoshito T, White J. Dissecting intracranial aneurysm. Surg Neurol 1977, 8:407-415.

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Set 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Akira Y. Diagnosis and treatment of vertebral aneurysms. J Neurosurg 1988, 69:345-349.

[2] 2. Alexander CB, Burger PC, Goree JA. Dissecting aneurysms of the basilar artery in 2 patients. Stroke 1979, 10:294-298.

[3] 3. Berger MS, Wilson CG. Intracranial dissecting aneurysms of the posterior circulation: report of six cases and review of the literature. J Neurosurg 1984, 61 : 882-894.

[4] 4. Bladin PF. Dissecting aneurysm of carotid and vertebrbal arteries. Vasc Surg 1974, 8:202-223.

[5] 5. Bogousslavsky J, Despland P, Regli F. Spontaneous carotid dissection with acute stroke. Arch Neurol 1987, 44:137-140.

[6] 6. Brilhaye J, Retif J, Jeanmart L, Flament-Duran DJ. Occlusion of the basilar artery in young patients. Acta Neurochirurg 1971, 25:225-229.

[7] 7. Caplan R. Migraine and vertebrobasilar ischemia. Neurology 41:55-61.

[8] 8. Chapleau CE, Robertson JT. Spontaneous cervical artery dissection: outpatient treatment with continuous heparin infusion using a totally implantable infusion device. Neurosurgery 1981, 8:83-87.

[9] 9. Farrel MA, Gilbert JJ, Kaufmann JCE. Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psichiatry 1985, 48:111-121.

[10] 10. Fisher CM. The headache and pain of spontaneous carotid dissection. Headache 1982, 22:60-65.

[11] 11. Friedman AH, Drake CG. Subarachnoid hemorrhage from intracranial dissecting aneurysms. J Neurosurg 1984, 60 : 325-334.

[12] 12. Garcia-Merino JA, Gutierrez JA, Lopes-Lozano JJ, Marqueza M, Lopez F, Liano H. Double lumen dissecting aneurysms of the internal carotid artery in fibromuscular dysplasia: case report. Stroke 1983, 14:815-818.

[13] 13. Gauthier G, Rohr J, Wild E. L'hématome dissequant de l'artère carotide interne: revue générale de 205 cas publiés dont dix personnels. Schw Arch Neurol Neurochir Psycriatry 1985, 136:53-74.

[14] 14. Hart RG, Easton JD. Dissections of cervical and cerebral arteries. Neurologic Clinics (Symposium on Cerebrovascular Disease) 1983, 1:155-182.

[15] 15. Hegedus K. Reticular fiber deficiency in the intracranial arteries of patients with dissecting aneurysm and review of the possible pathogenesis of previously reported cases. Eur Arch Psychiat Neurol Sci 1985, 235:102-106.

[16] 16. Hcchberg FH, Bean C, Fisher CM, Roberson GH. Stroke in a 15-year-old girl secondary to terminal carotid dissection. Neurology 1975, 25:725-729.

[17] 17. Hugenholtz H, Polrupa R, Montpetit VJA, Nelson R, Richard MT. Spontaneous dissecting aneurysm of the extracranial vertebral artery. Neurosurgery 1982, 10:96-100.

[18] 18. Kunze ST, Schiefer W. Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery. Neuroradiology 1971, 2:201-206.

[19] 19. Manz HJ, Messenhop AP. Dissecting aneurysm of intracranial vertebral artery: case report and review of literature. J Neurol 1983, 230:25-35.

[20] 20. Masanori Y, Kenzo T, Takefumi M, Kazuhiko S. Cerebral dissecting aneurysms in patients with moya-moya disease: report of two cases. J Neurosurg 1983, 58:120-125.

[21] 21. Schellas KP, Latchaw RE, Wendling L, Gold HA. Vertebrobasilar injuries following cervical manipulation. Jama 1980, 244:1450-1453.

[22] 22. Schinichiro M, Akira Y, Keniehi K, Hiromi F. A dissecting aneurysm of the vertebral artery. Surg Neurol 1984, 21:171-174.

[23] 23. Senter HJ, Sazwaz M. Nontraumatic dissecting aneurysms of the vertebral artery: case report. J Neurosurg 1982, 56:128-130.

[24] 24. Shiro W, Kiyoshige F, Yoshito M. Dissecting aneurysm of the vertebral artery. Surg Neurol 1978, 10:237-139.

[25] 25. Sinclair W Jr. Dissecting aneurysm of the middle cerebral artery associated with migraine syndrome. Am J Pathol 1953, 29:1083-1091.

[26] 26. Takeyoshi S, Kuniaki B, Keiji N, Kazufumi I. Dissecting aneurysm of the vertebral artery: report of seven cases and angiographic findings. J Neurosurg 1984, 61:1038-1046.

[27] 27. Tomokiro M, Goldberg HI, Parr J, Harper C, Thompson CJ. Cerebral dissecting aneurysm and intimai fibro-elastic thickening of cerebrall arteries: case report. J Neurosurg 1982, 56:571-576.

[28] 28. Turnbull HM. Alterations in arterial structures, and their relation to syphilis. Q J Med 1915, 8:201-254.

[29] 29. Waga S, Fujimoto K, Morooka Y. Dissecting aneurysm of the vertebral artery. Surg Neurol 1978, 10:237-239.

[30] 30. Watson AJ. Dissecting aneurysm of arteries other than the aorta. J Pathol Bacteriol 1956, 72:439-449.

[31] 31. West EET, Davies RJ, Kelly RE. Horner's syndrome and headache due to carotid artery disease. Br Med J 1976, 1:818-820.

[32] 32. Yonas H, Agamanolis D, Yoshito T, White J. Dissecting intracranial aneurysm. Surg Neurol 1977, 8:407-415.