Ohara Jiro, Yamao Yukihiro, Ishii Akira, Shimizu Hironori, Kikuchi Takayuki, Takenobu Yohei, Komatsu Katsuya, Ikeda Hiroyuki, Inada Taku, Nishi Hidehisa, Abekura Yu, Miyamoto Susumu
Department of Neurosurgery, Kyoto University Graduate School of Medicine.
No Shinkei Geka. 2019 Jan;47(1):97-103. doi: 10.11477/mf.1436203902.
Segmental arterial mediolysis(SAM)is a rare non-inflammatory and non-atherosclerotic arteriopathy associated with the occurrence of multiple aneurysms such as intracranial and intraperitoneal aneurysms. We report a case of intraperitoneal hemorrhage that occurred during the acute stage of subarachnoid hemorrhage(SAH). An 82-year-old woman presented with a sudden onset of loss of consciousness with a diagnosis of SAH. Digital subtraction angiography demonstrated two consecutive vertebral artery-posterior inferior cerebellar artery aneurysms. The larger aneurysm, which seemed to be ruptured, was successfully treated by coil embolization. On the 9th day after the onset of SAH, she developed aphasia secondary to the cerebral vasospasm. After selective intra-arterial infusion of fasudil hydrochloride, she was observed to maintain elevated systolic blood pressure. Her aphasia improved; however, on the 14th day, she suddenly developed hemorrhagic shock. An abdominal computed tomography scan demonstrated intraperitoneal hemorrhage secondary to a ruptured fusiform aneurysm of the right gastroepiploic artery. The lesion was successfully treated by coil embolization, although she became bedridden. Although a histopathological examination was not performed, her clinical, radiological, and serological presentation met the criteria of the clinical diagnosis of SAM. Elevated systolic blood pressure and excessive release of catecholamines in the acute stage of SAH might have caused the intraperitoneal hemorrhage. Non-saccular ruptured intracranial aneurysms should be considered among the differential diagnoses of SAM. In such cases, identifying and monitoring intraperitoneal aneurysms might be useful for earlier diagnosis and treatment of SAM, especially in the acute stage after SAH.
节段性动脉中层溶解（SAM）是一种罕见的非炎性、非动脉粥样硬化性动脉病，与颅内和腹腔内动脉瘤等多个动脉瘤的发生相关。我们报告一例蛛网膜下腔出血（SAH）急性期发生的腹腔内出血病例。一名82岁女性突发意识丧失，诊断为SAH。数字减影血管造影显示连续两个椎动脉 - 小脑后下动脉动脉瘤。较大的似乎已破裂的动脉瘤通过弹簧圈栓塞成功治疗。SAH发病后第9天，她因脑血管痉挛出现失语。选择性动脉内输注盐酸法舒地尔后，观察到她的收缩压持续升高。她的失语有所改善；然而，在第14天，她突然发生失血性休克。腹部计算机断层扫描显示右侧胃网膜动脉梭形动脉瘤破裂导致腹腔内出血。尽管她卧床不起，但该病变通过弹簧圈栓塞成功治疗。虽然未进行组织病理学检查，但她的临床、影像学和血清学表现符合SAM的临床诊断标准。SAH急性期收缩压升高和儿茶酚胺过度释放可能导致了腹腔内出血。非囊状破裂颅内动脉瘤应被纳入SAM的鉴别诊断。在这种情况下，识别和监测腹腔内动脉瘤可能有助于SAM的早期诊断和治疗，尤其是在SAH后的急性期。
