Clinical Study of Vertebral Dissecting Aneurysm Manifesting as Subarachnoid Hemorrhage Following Head-nuchal Pain

We report 3 patients who developed subarachnoid hemorrhage (SAH) from the vertebral dissecting aneurysm after head-nuchal pain. All 3 patients developed sudden head-nuchal pain, at the onset of which no subarachnoid hemorrhage was observed on CT (n=2) or on CT and MRI (n=1). Subsequently, SAH occurred within 1 or 2 days. All 3 patients were men aged 46 to 55 years, and had a Hunt and Kosnik Grade of III (n=1) or V (n=2) at admission. Vertebral angiography revealed aneurysmal dilatation with narrowing, but no posterior inferior cerebeller artery (PICA) involvement in any of the patients. All patients were treated for proxymal occlusion, including aneurysm, using GDC coils. In 1 patient, decompressive craniectomy was performed due to progression of a thrombosis to the PICA, and cerebeller and brain stem infarction. The Glasgow Outcome Scale (GOS) was good recovery in 2 patients. The patient who underwent decompressive craniectomy presented quadriplegia and had a score of Vegetative State. Although dissecting vertebral aneurysm presenting with head-nuchal pain and/or ischemic symptoms generally carry a favorable prognosis, we should be careful that it might associated with SAH as shown in the present case.