A syndrome of spontaneous cerebral and cervical artery dissections with angiolipomatosis

Report of two cases

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✓ A primary or systemic arteriopathy is frequently suspected in patients with spontaneous cerebral or cervical artery dissections. The authors report on two patients with such dissections accompanied by angiolipomatosis, a previously unreported association, and propose a common developmental defect in these patients.

A 50-year-old man with subcutaneous angiolipomatosis developed painful monocular blindness. Angiography studies revealed a spontaneous extracranial internal carotid artery (ICA) dissection and an ipsilateral fusiform intracranial ICA aneurysm. The ICA dissection was treated with aspirin, and after 6 months a craniotomy was performed. The aneurysm was found to be fusiform; it involved the entire supraclinoid portion of the ICA, and was wrapped with cotton. A 49-year-old man with a congenitally bicuspid aortic valve and subcutaneous angiolipomatosis developed posterior neck pain. Magnetic resonance imaging and angiography demonstrated a fusiform distal vertebral artery aneurysm. A craniotomy was performed and the aneurysm was found to incorporate the posterior inferior cerebellar artery as well as a perforating artery; the lesion was wrapped with cotton.

The tunica media of the arteries of the head and neck as well as the aortic valvular cusps are derived from neural crest cells, and angiolipomatosis has been associated with tumors of neural crest derivation. These associations indicate that a neural crest disorder may be the underlying abnormality in these patients.

Article Information

Address reprint requests to: Wouter I. Schievink, M.D., Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, California 90048. email: schievinkw@cshs.org.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Lateral left common CA angiogram exhibiting a flamelike occlusion (arrowheads) of the ICA, typical of an acute dissection. Right: Lateral VA angiogram demonstrating an aneurysm (arrowhead) in the supraclinoid portion of the left ICA, filling through a large posterior communicating artery.

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    Photomicrograph demonstrating small vascular (capillary) proliferations and mature adipocytes in an angiolipoma. Masson trichrome, original magnification × 200.

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    A T1-weighted sagittal MR image displaying a 1.5-cm premedullary aneurysm (arrowhead). Note the crescentic area of subacute hematoma in the wall of the aneurysm, consistent with dissection.

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    Left: Lateral right VA angiogram demonstrating a fusiform aneurysm of the distal right VA (arrowhead). Right: Right oblique CA angiogram revealing marked tortuosity of the extracranial ICA.

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