Journal of Korean Society of Geriatric Neurosurgery 2016;12(2):103-108.
Published online September 30, 2016.
Differences of Intracranial Dissection on Anterior and Posterior Circulation with Respect to Clinical Features and Efficacy of Medical Treatment in Elderly Patients
Joon Bok Jeon , Yu Shik Shim , Dong-Keun Hyun , Se-yang Oh
Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea
We investigated the clinical features of intracranial dissection in elderly patients, including initial and follow‐up radiologic findings to analyze differences between anterior and posterior circulation.
Medical records and radiologic findings of patients over 60 years of age and diagnosed with intracranial dissection were selected. Computed tomography (CT), and magnetic resonance imaging (MRI) were performed on all patients. After treatment, a follow-up imaging study was performed between 3-6 months to six months after discharge.
A total of 20 patients were enrolled in this study. Six patients showed intracranial dissection of the anterior circulation and 14 patients showed intracranial dissection of the posterior circulation. In the anterior circulation group, dissection with acute infarction was found in five patients. In the posterior circulation group, dissection with acute infarction was found in five patients. Patients were treated with antiplatelet agents or an anticoagulant with strict blood pressure control. The outcomes were favorable in 15 patients but an intracranial hemorrhage (ICH) occurred in one patient after treatment with an anticoagulant.
We found that acute infarction due to the intracranial dissection is more frequent in anterior circulation than posterior circulation but dissecting aneurysm and subarachnoid hemorrhage (SAH) in more frequent in posterior circulation than anterior circulation in elderly patients. Also, in most of elderly patients with intracranial dissection, both antiplatelet agents and anticoagulants result in favorable outcomes but antiplatelet agents can be suitable choice to prevent stroke because of the high bleeding risk associated with anticoagulant use in elderly patients.
Key Words: Anterior Cerebral Artery, Cerebral Infarction, Dissection, Middle Cerebral Artery, Subarachnoid Hemorrhage, Vertebral artery
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