Dissecting intracranial aneurysms presenting as subarachnoid haemorrhage: report of two cases and review of literature

Subarachnoid haemorrhage due to intracranial non-traumatic dissecting aneurysms is rare. Most of the published reports refer to dissecting aneurysms in the vertebrobasilar territory. Anterior circulation dissecting aneurysms are rare and their pathogenesis, clinical features, angiographic findings and management are a matter of debate. Management of patients with intracranial arterial dissection is unclear. Unlike the well-established proximal occlusion and trapping approaches to vertebral artery dissections, choices of interventions for anterior circulation and basilar dissecting aneurysms are limited, and most reports have been limited to wrapping techniques for arterial wall reinforcement. The role of anticoagulation therapy in the presence of subarachnoid haemorrhage is also a matter of debate. As no clear-cut guidelines are available, treatment should be tailored to the individual patient. We describe two cases of intracranial dissecting aneurysms, which presented as subarachnoid haemorrhage (SAH) and discuss the management issues.