Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
J Neurosurg. 2012 May;116(5):948-51. doi: 10.3171/2012.1.JNS111967. Epub 2012 Mar 2.
The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A(1) segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A(1) segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.
作者报告了一例罕见的节段性动脉中层溶解症（SAM）伴颅内和腹腔内动脉瘤的病例，该患者因颅内动脉瘤破裂而发生蛛网膜下腔出血（SAH）。这种疾病主要累及腹腔动脉系统，导致大多数情况下发生腹腔内和腹膜后出血。患者表现为严重头痛和呕吐。头部 CT 扫描显示 SAH。脑血管造影显示 3 个动脉瘤：1 个位于右侧大脑前动脉（ACA）远端，1 个位于右侧 ACA A1 段远端，1 个位于左侧椎动脉。患者有多个腹腔内动脉瘤的病史，涉及脾、胃网膜、胃十二指肠和双侧肾动脉。他接受了右侧额颞部开颅术和右侧 ACA A1 段远端夹层动脉瘤的纤维蛋白涂层，这是出血的原因。随访显示颅内和腹腔内残余动脉瘤无明显变化。SAM 伴多发腹腔内动脉瘤引起的 SAH 极为罕见。作者描述了他们的特殊病例，并回顾了与 SAM 伴颅内和腹腔内动脉瘤相关的文献。
