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 ().
This 37-year-old man with hypertension came to the Emergency room with complaints of sudden onset headache and right leg weakness after he stretched and yawned. Neurological examination showed alert mental state, frontal headache, and grade III weakness of the right leg. He had no remarkable past medical history, except nonspecific dizziness and headache since he was 25 years old. Head computed tomogram (CT) revealed scattered SAH at the left frontal convexities. A magnetic resonance (MR) images showed acute infarction at the rostrum of the left corpus callosum and double-lumen signal with high-signal hemorrhage (). Catheter angiogram showed multifocal dissections at the left carotid bulb and right vertebral artery with tiny aneurysm at the left proximal A2 (). His paresis seemed to be attributed to the infarction. After 3 days, dual antiplatelet agents were prescribed to prevent further ischemia and his weakness was gradually improved.\nHe underwent two more CT angiograms during the next months. Final angiogram revealed enlargement of the left A2 aneurysm and progression of focal stenosis along the ACA (). Endovascular intervention was performed under a general anesthesia by placing a 4.5×28 mm Enterprise stent (Cordis Neurovascular, Miami Lakes, FL, USA) through the A1 into the A2 segment, and deploying three Axium detachable helix coils (ev3 Inc., Irvine, CA, USA) into the aneurysm sac. Postoperative control angiogram revealed successful coil packing and flow preservation through the bilateral A2 segments (). Six months postoperatively, angiogram showed neither growth of aneurysms nor recurrence of stenosis (). He has no neurologic deficits and awaits another angiogram 12 months hereafter.