Shuaib Umar Ashfaq, Kate Mahesh, Homik Joanne, Jerrakathil Thomas
Shifa College of Medicine, Islamabad, Pakistan.
BMJ Case Rep. 2013 Jun 13;2013:bcr2013008825. doi: 10.1136/bcr-2013-008825.
Aneurysmal subarachnoid haemorrhage (SAH) is rarely associated with Takayasu's arteritis (TA). The present report describes a 21-year-old woman with recurrent SAH and TA. In addition, she also had recurrent spells of postural weakness in the bilateral lower limb occurring at the same time. Sequential CT of the head and MRI showed bilateral cortical SAH. Vascular imaging with MR angiogram and CT angiogram showed bilateral subclavian arteries and left common carotid artery occlusion with multiple hypertrophied collaterals vessels in the neck. There was no evidence of aneurysms in the intracranial vasculature in the conventional angiogram. The CT angiogram of the aorta showed severe stenosis of the abdominal aorta above the renal arteries. The patient was treated with immunomodulatory therapy and had a favourable outcome without further recurrence at end of 1 year of follow-up. A review of the literature showed 21cases with aneurysmal SAH and three cases non-aneurysmal SAH in patients with TA have been reported. Various factors are responsible for the reorganisation of the intracranial of the arteries in patients with chronic vasculitis in the presence of extracranial stenosis and occlusion, which could possibly explain the SAH in absence of aneurysm in patients with TA.
动脉瘤性蛛网膜下腔出血（SAH）很少与大动脉炎（TA）相关。本报告描述了一名患有复发性SAH和TA的21岁女性。此外，她还同时出现双侧下肢反复性姿势性无力。头颅连续CT和MRI显示双侧皮质SAH。磁共振血管造影和CT血管造影的血管成像显示双侧锁骨下动脉和左颈总动脉闭塞，颈部有多个增粗的侧支血管。传统血管造影未发现颅内血管有动脉瘤迹象。主动脉CT血管造影显示肾动脉上方腹主动脉严重狭窄。该患者接受了免疫调节治疗，随访1年末无进一步复发，预后良好。文献回顾显示，已报道21例TA患者合并动脉瘤性SAH，3例合并非动脉瘤性SAH。在存在颅外狭窄和闭塞的情况下，各种因素导致慢性血管炎患者颅内动脉重构，这可能解释了TA患者无动脉瘤时发生SAH的原因。
