An 80-year-old male with severe constipation experienced a sudden headache during defecation. Shortly after, he visited local clinic for medication and abrupt left hemiplegia occurred. He was in a drowsy state and had dysarthria. The NIHSS score was 12. The brain MRI revealed a pontine infarction (). The T1-weighted image demonstrated a mural thickening with hyperintensity at the right anterior wall of the basilar artery (). On the vertebral angiogram, a contrast filling defect was found on the right anterior wall of the mid-basilar artery which was responsible for the luminal stenosis. Based on these radiological findings, a right anterior wall dissection of the basilar artery with mural hematoma was suspected. Similar to those angiographic findings on Case 1, the postero-superior border of the defect where the intimalflap might exist had a smooth and clear margin, and the inferior border where the mural hematoma and false lumen might be exposed had an irregular and unclear margin ().\nDuring the angiographic evaluation, his motor power dramatically improved to grade III. He had full recovery after conservative treatments including administration of low-molecular heparin and antiplatelet agent. Follow-up vertebral angiogram after two weeks demonstrated a fusiform aneurysmal dilatation with clearly visible intimal flap (). Since such aneurysmal formation caused by the enlargement of the false lumen has an extremely fragile wall and its rupture seemed to have a high mortality rate, an endovascular treatment was performed. Double stents were inserted into the true lumen fully covering the diseased segment. After the stenting, the false lumen was somewhat collapsed, but some residual false lumen was still visible (). Follow-up angiogram at two months after the initial ischemic onset demonstrated a complete healing of the dissection (). He remained in a symptom free state.
A 48-year-old female presented with a sudden bursting headache and right hemiparesis of grade I/V. Initial brain computed tomography (CT) showed an obvious SAH at the anterior interhemispheric fissure and left superior frontal sulcus (). Conventional cerebral angiography showed abrupt luminal tapering of the left distal ACA with compromised distal flow (). Her brain magnetic resonance imaging (MRI) showed an acute cerebral infarction in the left ACA vascular territory ().\nConservative treatment was administered since the area of infarction matched the presumed territory of the occluded ACA without penumbra zone and further revascularization might not guarantee any benefit. Three months later, she was able to walk unassisted with minor motor weakness of grade IV/V on her right leg. She underwent repeated follow-up cerebral angiographies which showed remarkable arterial healing. Follow-up angiography after 33 months showed complete luminal healing without aneurysmal formation ().