Dissecting aneurysms in the neck and head

Abstract

The case of a 30-year-old female with a history of migraine, who died with a subintimal dissecting aneurysm of the right internal carotid and middle cerebral arteries, is presented. Bilateral carotid arteriograms demonstrated complete occlusion of the right internal carotid and partial occlusion of the right middle cerebral with an asymmetric serrated defect. This type of defect in a young person without evidence of atherosclerosis may indicate dissecting aneurysm. The postulated etiologies of 17 other cases of cerebral dissecting aneurysms are considered and grouped into 5 categories: congenital, medial necrosis, trauma, migraine, and syphilis. No single etiology explains the majority of cases, although the subintimal location of many dissections indicates a different mechanism than that causing aortic dissections. The available reports of carotid artery dissecting aneurysms in the neck suggest that angiographic needling is the most common etiologic factor.