Republished: MRI SPACE sequence confirmation of occluded MCA M2 dissection stump masquerading as a ruptured MCA aneurysm

Intracranial vascular pathologies often have overlapping clinical presentations. Dissected vessel occlusions and bifurcation aneurysms can appear similar on pretherapeutic imaging. The medical management of these two entities is drastically different. The patient is a 51-year-old man who presented w...

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Bibliographic Details
Published inJournal of neurointerventional surgery Vol. 11; no. 11; p. e10
Main Authors Khattar, Nicolas K, White, Andrew C, Adams, Shawn W, Aljuboori, Zaid S, Wilder, Michael J, Downs, Richard K, James, Robert F
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.11.2019
Subjects
Aneurysm, Ruptured - diagnostic imaging
Aneurysm, Ruptured - surgery
Aneurysms
Dissection
Humans
Infarction, Middle Cerebral Artery - diagnostic imaging
Infarction, Middle Cerebral Artery - surgery
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - surgery
Male
Medical imaging
Middle Aged
Middle Cerebral Artery - diagnostic imaging
Middle Cerebral Artery - surgery
Neurosurgery
Veins & arteries
aneurysm
ct angiography
artery
mri
angiography
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Summary:Intracranial vascular pathologies often have overlapping clinical presentations. Dissected vessel occlusions and bifurcation aneurysms can appear similar on pretherapeutic imaging. The medical management of these two entities is drastically different. The patient is a 51-year-old man who presented with severe, sudden-onset headache. Initial presentation was consistent with a ruptured middle cerebral artery (MCA) aneurysm and surgical clipping was recommended. However, further review of radiographic findings could not definitively differentiate an aneurysmal origin of the symptoms as opposed to intracranial dissection followed by occlusion of the M2 branch of the MCA. MRI sampling perfection with application optimised contrasts using different flip angle evolution (SPACE) was performed and showed thin flow signalling distal to the dissected vessel stump confirming the diagnosis. Accurate diagnosis is a crucial step in directing treatment for intracranial vascular lesions. MRI SPACE is a simple tool in the diagnostic armamentarium to adequately direct treatment and avoid the potential for unnecessary interventions.
Bibliography:ObjectType-Case Study-2
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ISSN:1759-8478
1759-8486
DOI:10.1136/neurintsurg-2018-013996.rep