Yasuda Shoji, Egashira Yusuke, Ogiso Mamoru, Kobayashi Hiroki, Taguchi Kohtaro, Matsumoto Munekazu, Kotani Yoshinori, Miyazaki Tatsuhiko, Noda Shinji
Department of Neurosurgery, Chubu Neurorehabilitation Hospital, Minokamo, Japan.
Department of Neurosurgery, Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Minokamo, Japan.
J Neurosurg Case Lessons. 2025 Mar 10;9(10). doi: 10.3171/CASE24810.
Segmental arterial mediolysis (SAM) is a rare, noninflammatory vascular disease primarily affecting small to medium arteries. Although neurological presentations like subarachnoid hemorrhage (SAH) and ischemic stroke have been reported, awareness of SAM in neurology remains limited. The authors present a unique case of SAM with SAH following chronic internal carotid artery (ICA) dissection and explore the clinical course and potential ethnic implications of the disease.
A 56-year-old Japanese man with a history of left ICA dissection presented with sudden-onset headache and loss of consciousness. Imaging revealed a diffuse SAH caused by a ruptured vertebral artery aneurysm. Despite initial conservative treatment and subsequent coil embolization, the patient's condition deteriorated, and he died on day 10. Postmortem examination revealed multiple arterial dissections and medial degeneration, confirming SAM.
Physicians specializing in vascular diseases should pay attention to the possibility and management of SAM in patients with multiple arterial lesions, including neurological fields. SAM involving craniocervical vessels presents a high risk of morbidity and mortality. Early recognition and appropriate management are crucial, particularly in neurovascular cases. https://thejns.org/doi/10.3171/CASE24810.
节段性动脉中层溶解（SAM）是一种罕见的非炎症性血管疾病，主要影响中小动脉。尽管已有蛛网膜下腔出血（SAH）和缺血性卒中之类的神经学表现的报道，但神经学领域对SAM的认识仍然有限。作者报告了1例慢性颈内动脉（ICA）夹层分离后出现SAH的SAM独特病例，并探讨了该疾病的临床病程及潜在的种族影响因素。
一名有左侧ICA夹层分离病史的56岁日本男性，出现突发头痛和意识丧失。影像学检查显示由椎动脉动脉瘤破裂所致的弥漫性SAH。尽管最初采取了保守治疗及随后进行了弹簧圈栓塞，但患者病情仍恶化，并于第10天死亡。尸检发现多处动脉夹层分离和中层退变，确诊为SAM。
包括神经学领域在内，血管疾病专科医生应关注存在多发动脉病变患者发生SAM的可能性及处理。累及颅颈血管的SAM具有较高的发病和死亡风险。早期识别和恰当处理至关重要，尤其是在神经血管病例中。https://thejns.org/doi/10.3171/CASE24810 。
