Dissecting Aneurysm of M3 Portion of the Middle Cerebral Artery after Drainage of Hypertensives Intracerebral Hemorrhage: A Case Report

Abstract

Background: The dissecting aneurysm of M3 (the middle cerebral artery runs outwards from the top of the annular sulcus to the surface of the Sylvian fissure) portion of the middle cerebral artery caused by hypertensives intracerebral hemorrhage (HICH) drainage is very rare. Thus, it can be easily misdiagnosed and its treatment is challenging. Once occurred, it is able to develop into secondary cerebral artery infarction or rebleeding, leading to serious neurological damage. Methods: This is a case study involving one patient that suffered HICH drill drainage. A follow-up Magnetic resonance imaging (MRI) in outpatient clinic after HICH drainage was performed9 months ago. The MRI results revealed an abnormal shadow in the left temporal lobe. The cerebral angiography confirmed that there was a dissecting aneurysm in the M3 segment of the middle cerebral artery with severe stenosis of the diseased vessel, along with slow distal blood flow. Aneurysm of M3 portion of the middle cerebral artery was dissected after drainage of hypertensives intracerebral hemorrhage. The patient underwent the dissection vessel isolation and vascular reconstruction. Results: There was no neurological dysfunction after surgery, the diseased vessels were unobstructed and the contralateral limb muscle strength of the patient significantly improved in the followed up after 2 months postoperation. Conclusions: MRI should be investigated as early as possible in patients with Intracranial arterial dissection (IAD) after intracranial surgery, especially when patient’s functional recovery differs from the preoperative prognostic determination.