1
|
Matsuura C, Fuchinoue Y, Terazono S, Kondo K, Harada N, Sugo N. Intraperitoneal hemorrhage due to segmental arterial mediolysis associated with cerebral vasospasm after subarachnoid hemorrhage. Clin Case Rep 2022; 10:e6371. [PMID: 36188053 PMCID: PMC9487451 DOI: 10.1002/ccr3.6371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
A man in his 50s with no significant past medical history developed subarachnoid hemorrhage due to ruptured left middle cerebral artery aneurysm. On the ninth hospital day, he had a ruptured visceral aneurysm with segmental arterial mediolysis, and we successfully treated with transarterial embolization using metallic coils.
Collapse
Affiliation(s)
- Chie Matsuura
- Department of Neurosurgery Toho University Omori Medical Center Tokyo Japan
| | - Yutaka Fuchinoue
- Department of Neurosurgery Toho University Omori Medical Center Tokyo Japan
| | - Sayaka Terazono
- Department of Neurosurgery Toho University Omori Medical Center Tokyo Japan
| | - Kosuke Kondo
- Department of Neurosurgery Toho University Omori Medical Center Tokyo Japan
| | - Naoyuki Harada
- Department of Neurosurgery Toho University Omori Medical Center Tokyo Japan
| | - Nobuo Sugo
- Department of Neurosurgery Toho University Omori Medical Center Tokyo Japan
| |
Collapse
|
2
|
Tao Y, Matsubara S, Yagi K, Kinoshita K, Fukunaga T, Yamamoto A, Uno M. Intra-abdominal hemorrhage due to segmental arterial mediolysis of an ovarian artery pseudoaneurysm and concomitant aneurysmal subarachnoid hemorrhage: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22233. [PMID: 36088559 PMCID: PMC9706337 DOI: 10.3171/case22233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is one of the most severe neurosurgical diseases in which systemic management is important from the acute phase to the chronic phase. The authors reported a case of aneurysmal SAH associated with intra-abdominal hemorrhage possibly caused by segmental arterial mediolysis (SAM). OBSERVATIONS A 60-year-old woman collapsed suddenly at home. On arrival at our hospital, she was comatose and her head computed tomography (CT) showed SAH, probably from an anterior cerebral artery aneurysm. Simultaneous body CT to screen for pneumonia associated with COVID-19 incidentally detected an intra-abdominal hematoma and the bleeding point. Emergent ventriculostomy was conducted first. Because abdominal angiography detected a ruptured pseudoaneurysm of an ovarian artery, emergency embolization was subsequently performed for hemostasis. However, she deteriorated again, and her pupils became fully dilated. The patient died on day 3 of hospitalization. LESSONS Patients with aneurysmal SAH rarely have intra-abdominal hemorrhage in the acute stage and may have a fatal outcome. Intra-abdominal hemorrhage should be suspected in the setting of unstable vital signs, and prompt treatment is necessary.
Collapse
Affiliation(s)
| | | | | | | | | | - Akira Yamamoto
- Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | | |
Collapse
|
3
|
Tokuda T, Tajiri S, Ueda Y, Ohmori Y, Mukasa A. A case of subarachnoid hemorrhage caused by multiple cerebral aneurysms due to segmental arterial mediolysis. Surg Neurol Int 2022; 13:175. [PMID: 35509548 PMCID: PMC9062942 DOI: 10.25259/sni_282_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Segmental arterial mediolysis (SAM) is a condition in which an aneurysm is formed by causing lysis of the media and remodeling of blood vessels. Short-term recurrence has been reported in abdominal aortic aneurysms. Cerebral aneurysms have been suggested to form in a short period not only in the abdominal cavity but also in the intracranial arteries in SAM. Case Description: A 36-year-old pregnant woman at 35 weeks’ gestation developed sudden headache and disorientation. Head magnetic resonance imaging showed a small amount of subarachnoid hemorrhage in the right ambient cistern. A fusiform cerebral aneurysm was found in the periphery of the right superior cerebellar artery, and small saccular aneurysms were found in the periphery of the right posterior cerebral artery and left posterior inferior cerebral artery. After delivery of the fetus, endovascular embolization of the ruptured aneurysm was performed. However, 10-week postoperatively, she developed sudden headache. Hemorrhage was found in the fourth ventricle, and enlargement of the left posterior inferior cerebellar artery (PICA) peripheral aneurysm and disappearance of the right posterior cerebral artery peripheral aneurysm were confirmed. A ruptured aneurysm in the peripheral left PICA was removed after trapping. Intraoperatively, an unruptured thrombosed aneurysm that was not visualized by imaging was also removed. Histopathological examination showed no calcification or inflammation, rupture of the internal elastic lamina, and lack of segmentation, and SAM was diagnosed. Conclusion: In atypical dissecting aneurysms, SAM should be considered as a differential diagnosis. Systemic examination and short-term follow-up are also necessary.
Collapse
Affiliation(s)
- Takaho Tokuda
- Department of Neurosurgery, Minamata City General Hospital and Medical Center, Kumamoto,
| | - Seiji Tajiri
- Department of Neurosurgery, Minamata City General Hospital and Medical Center, Kumamoto,
| | - Yutaka Ueda
- Department of Neurosurgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka,
| | - Yuki Ohmori
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| |
Collapse
|
4
|
Ota K, Matsubara N. A Case of Segmental Arterial Mediolysis: Hemoperitoneum with Hemorrhagic Shock due to Rupture of a Visceral Artery Aneurysm Following Subarachnoid Hemorrhage. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:189-194. [PMID: 37502735 PMCID: PMC10370665 DOI: 10.5797/jnet.cr.2020-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/03/2020] [Indexed: 07/29/2023]
Abstract
Objective Segmental arterial mediolysis (SAM) is a non-inflammatory and non-atherosclerotic vascular disease characterized by segmental medial defect/necrosis of muscular arteries as a result of mediolysis. SAM affects the visceral and intracranial arteries, and causes arterial dissection and aneurysm. We report a case of aneurysmal subarachnoid hemorrhage (SAH) followed by hemoperitoneum due to a ruptured visceral artery aneurysm. Case Presentation A 54-year-old man developed SAH from a ruptured anterior communicating artery aneurysm, which was clipped on the same day. Thereafter, he was treated to prevent cerebral vasospasm. Six days after onset, he developed acute anemia and his blood pressure decreased, suggesting hemorrhagic shock. Hemoperitoneum was detected on computed tomography and abdominal angiography was performed. Irregular and stenotic arterial findings, and an unusual aneurysm with contrast stasis were found in a branch vessel from the right gastroepiploic artery. SAM was diagnosed based on the clinical course and angiographic characteristics. Endovascular treatment consisted of embolization of the visceral artery aneurysm with liquid embolic material. after embolization, the vital signs stabilized and he recovered from shock. Acute treatment for SAH was continued. Although the patient did not develop vasospasm-related sequelae, he was transferred to the rehabilitation hospital 7 weeks after onset and his modified Rankin Scale score at 3 months after onset was 2. Conclusion Visceral artery aneurysm associated with SAM should be considered as the cause of hemoperitoneum with hemorrhagic shock during the acute phase of SAH.
Collapse
Affiliation(s)
- Keisuke Ota
- Department of Neurosurgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Noriaki Matsubara
- Department of Neurosurgery and Neuroendovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| |
Collapse
|
5
|
A Ruptured Blood Blister-Like Aneurysm Associated with Intraperitoneal Hemorrhage due to Segmental Arterial Mediolysis: A Case Report and Literature Review. World Neurosurg 2019; 134:79-85. [PMID: 31669242 DOI: 10.1016/j.wneu.2019.10.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic, noninflammatory vascular disease, characterized by mediolysis. We report an extremely rare case of subarachnoid hemorrhage (SAH) due to a ruptured blood blister-like aneurysm (BBA) of the internal carotid artery associated with SAM-related arteriopathy. CASE DESCRIPTION We experienced a case of SAH followed by intraperitoneal hemorrhage that occurred 12 days after the SAH onset. SAH was caused by a ruptured BBA of the internal carotid artery, which was treated by trapping with high-flow bypass. Intraperitoneal hemorrhage was caused by a rupture of a posterior inferior pancreaticoduodenal artery (PIPDA) aneurysm, which induced hypovolemic shock resulting in death in spite of endovascular internal trapping. Postmortem pathologic examination revealed that the PIPDA pseudoaneurysm was due to SAM. CONCLUSIONS We should pay attention to the association of SAM, which is a potentially life-threatening pathology when treating cerebral BBAs.
Collapse
|
6
|
Hayashi S, Hosoda K, Nishimoto Y, Nonaka M, Higuchi S, Miki T, Negishi M. Unexpected intraabdominal hemorrhage due to segmental arterial mediolysis following subarachnoid hemorrhage: A case of ruptured intracranial and intraabdominal aneurysms. Surg Neurol Int 2018; 9:175. [PMID: 30221020 PMCID: PMC6130153 DOI: 10.4103/sni.sni_129_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/20/2018] [Indexed: 01/17/2023] Open
Abstract
Background: Segmental arterial mediolysis (SAM) is an uncommon vascular disease, which manifests as catastrophic intraabdominal hemorrhage caused by rupture of visceral dissecting aneurysms in most cases. The etiology of SAM is still unclear, but SAM may be a vasospastic disorder and the responsible pressor agent is norepinephrine. Recently, abdominal SAM coexisting with intracranial dissecting aneurysms has been reported, but the relationship between intraabdominal and intracranial aneurysms in SAM remains unclear, as no cases of concomitant abdominal SAM and ruptured intracranial saccular aneurysm have been reported. Case Description: A 49-year-old woman underwent emergent clipping for a ruptured saccular aneurysm at the left C1 portion of the internal carotid artery. Intraoperatively, norepinephrine was continuously administered intravenously under general anesthesia. Four days after the subarachnoid hemorrhage (SAH), the patient suddenly developed shock due to massive hematoma in the abdominal cavity. Imaging showed multiple aneurysms involving the splenic artery, gastroduodenal artery, common hepatic artery, and superior mesenteric artery. Coil embolization of the splenic artery was performed immediately to prevent bleeding. Subsequent treatment for cerebral vasospasm following SAH was performed with prevention of hypertension, and the patient recovered with left temporal lobe infarction. The diagnosis was abdominal SAM based on the clinical, imaging, and laboratory findings. Conclusion: Norepinephrine release induced by SAH and/or iatrogenic administration of norepinephrine may have promoted abdominal SAM in this case. Abdominal SAM may occur subsequent to rupture of ordinary saccular aneurysm, and may provoke catastrophic abdominal hemorrhage in the spasm stage after SAH.
Collapse
Affiliation(s)
- Satoru Hayashi
- Department of Neurosurgery, Chikamori Hospital, Kochi, Japan
| | - Koji Hosoda
- Department of Radiology, Chikamori Hospital, Kochi, Japan
| | - Yo Nishimoto
- Department of Neurosurgery, Chikamori Hospital, Kochi, Japan
| | - Motonobu Nonaka
- Department of Neurosurgery, Chikamori Hospital, Kochi, Japan
| | - Shinya Higuchi
- Department of Neurosurgery, Chikamori Hospital, Kochi, Japan
| | - Toshifumi Miki
- Department of Emergency and Critical Care Medicine, Chikamori Hospital, Kochi, Japan
| | - Masatoshi Negishi
- Department of Emergency and Critical Care Medicine, Chikamori Hospital, Kochi, Japan
| |
Collapse
|
7
|
Hellstern V, Aguilar Pérez M, Kohlhof-Meinecke P, Bäzner H, Ganslandt O, Henkes H. Concomitant Retroperitoneal and Subarachnoid Hemorrhage Due to Segmental Arterial Mediolysis : Case Report and Review of the Literature. Clin Neuroradiol 2017; 28:445-450. [PMID: 29101412 PMCID: PMC6105144 DOI: 10.1007/s00062-017-0641-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- V Hellstern
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
| | - M Aguilar Pérez
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | | | - H Bäzner
- Neurologische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - O Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany
| | - H Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Germany
| |
Collapse
|
8
|
Welch BT, Brinjikji W, Stockland AH, Lanzino G. Subarachnoid and intraperitoneal hemorrhage secondary to segmental arterial mediolysis: A case report and review of the literature. Interv Neuroradiol 2017; 23:378-381. [PMID: 28443482 DOI: 10.1177/1591019917703074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Segmental arterial mediolysis (SAM) is an uncommon or underdiagnosed arteriopathy that presents with life-threatening hemorrhage. SAM can affect the intracranial, spinal, and visceral arteries, with reported cases of concomitant intracranial and visceral hemorrhage. Case description We present the case of a 61-year-old male with concurrent subarachnoid and intraperitoneal hemorrhage caused by simultaneously bleeding posterior spinal artery and splenic artery pseudoaneurysms. The posterior spinal artery pseudoaneurysms were treated with selective injection of polyvinyl alcohol particles into the posterior spinal artery, while the splenic artery pseudoaneurysm was treated with Gelfoam embolization. The constellation of imaging, clinical, and laboratory features led to a presumptive diagnosis of SAM, which remains the only reported cause of concurrent neurovascular and visceral artery aneurysm rupture. Conclusion SAM is a key diagnostic consideration in cases of concomitant intracranial, spinal, and visceral artery aneurysm rupture.
Collapse
Affiliation(s)
| | | | | | - Giuseppe Lanzino
- 1 Departments of Radiology, Mayo Clinic, USA.,2 Departments of Neurosurgery, Mayo Clinic, USA
| |
Collapse
|
9
|
Shinoda N, Hirai O, Mikami K, Bando T, Shimo D, Kuroyama T, Matsumoto M, Itoh T, Kuramoto Y, Ueno Y. Segmental Arterial Mediolysis Involving Both Vertebral and Middle Colic Arteries Leading to Subarachnoid and Intraperitoneal Hemorrhage. World Neurosurg 2015; 88:694.e5-694.e10. [PMID: 26724638 DOI: 10.1016/j.wneu.2015.12.058] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Segmental arterial mediolysis (SAM) is not yet well known in the neurosurgical field, even though it has become an increasingly recognized pathology in arterial dissection. CASE DESCRIPTION A case of SAM presented as subarachnoid hemorrhage (SAH) due to a dissecting aneurysm of the left intracranial vertebral artery (VA), which extended from the proximal VA union to the distal portion of the left posterior inferior cerebellar artery. The lesion was successfully embolized by an endovascular technique. However, subsequent intraperitoneal hemorrhage due to rupture of a fusiform aneurysm of the middle colic artery prompted surgical treatments. The features of the extirpated visceral vascular lesion were compatible with the diagnosis of SAM based on histopathologic examinations. CONCLUSIONS It is very important that SAM is recognized as a systemic disease that affects the central nervous system, visceral arteries, and coronary arteries. The possibility of SAM should always be considered, particularly in patients with ruptured VA dissection-which is nowadays treated by endovascular techniques-since concomitantly involved visceral arteries may cause unexpected hemorrhagic complications other than SAH.
Collapse
Affiliation(s)
- Narihide Shinoda
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
| | - Osamu Hirai
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Kazuyuki Mikami
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Toshiaki Bando
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Daisuke Shimo
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | | | | | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoji Kuramoto
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| | - Yasushi Ueno
- Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan
| |
Collapse
|