[Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage and brain infarction: a case report].

This report describes a surgical case of a dissecting aneurysm of the left middle cerebral artery with subarachnoid hemorrhage and ischemic insult. A 48-year-old man with pure motor aphasia was referred to our hospital. CT scans demonstrated subarachnoid hemorrhage in the left frontal region. CT scans on the next day showed a small brain infarction in the left precentral artery and central artery territories. The first left carotid angiograms showed stenosis at the M2 portion of the middle cerebral artery. On the 16th day, the second left carotid angiograms revealed a pearl and string sign. We diagnosed a dissecting aneurysm of the middle cerebral artery. The dissecting aneurysm was wrapped using the pterional approach and STA-MCA anastomosis was also performed. The postoperative course was uneventful and the motor aphasia improved.