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Subarachnoid hemorrhage due to nonbranching aneurysm of the middle cerebral artery in a young adult with a history of Kawasaki disease.

Ishida A, Matsuo S, Kawamura S, Nishikawa T - Surg Neurol Int (2014)

Bottom Line: The incidence of subarachnoid hemorrhage (SAH) in young adults is relatively rare.Two weeks later, the patient was discharged without any apparent neurological deficit.We also performed a circumstantial pathological study on specimens obtained from the aneurysm wall.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.

ABSTRACT

Background: The incidence of subarachnoid hemorrhage (SAH) in young adults is relatively rare. Kawasaki disease is a systemic vasculopathy that is known to cause coronary artery aneurysms; however, its effect on cerebral arteries remains largely unclear.

Case description: We report the case of a 20-year-old male with a history of Kawasaki disease who presented with SAH caused by the rupture of a nonbranching middle cerebral artery aneurysm. This is the third report of SAH associated with Kawasaki disease. Preoperative echocardiography of the patient rejected the presence of bacterial endocarditis and other heart abnormalities. An emergency craniotomy and clip occlusion of the aneurysm was successfully performed without obstructing the parent artery. Two weeks later, the patient was discharged without any apparent neurological deficit. We also performed a circumstantial pathological study on specimens obtained from the aneurysm wall. Our histological findings suggest that the elastic lamina and tunica intima were completely destroyed during the acute vasculitis phase of Kawasaki disease, which possibly led to the aneurysmal formation.

Conclusions: Lack of active inflammatory changes and atherosclerotic lesions may explain the chronic feature of Kawasaki disease, not a typical aneurysmal formation.

No MeSH data available.


Related in: MedlinePlus

Computed tomography (CT) of the patient at admission showed a thick subarachnoid hemorrhage (SAH) predominantly in the basal cistern and right Sylvian fissure (a). The SAH was spreading to the peripheral subarachnoid space and the brain seemed really tight (b). Three-dimensional CT angiography revealed an aneurysm arising from a distal point of the right middle cerebral artery bifurcation (c). Magnetic resonance (MR) angiography shows a clear image of the stalk-like and narrow aneurysm neck (d)
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Figure 1: Computed tomography (CT) of the patient at admission showed a thick subarachnoid hemorrhage (SAH) predominantly in the basal cistern and right Sylvian fissure (a). The SAH was spreading to the peripheral subarachnoid space and the brain seemed really tight (b). Three-dimensional CT angiography revealed an aneurysm arising from a distal point of the right middle cerebral artery bifurcation (c). Magnetic resonance (MR) angiography shows a clear image of the stalk-like and narrow aneurysm neck (d)

Mentions: A 20-year-old male experienced a sudden onset of headache, nausea, and vomiting. He was brought to a nearby hospital, where a head computed tomographic (CT) scan revealed SAH. He was immediately transferred to our hospital for emergency treatment. He had a history of Kawasaki disease, which was believed to be cured. He had severe atopic dermatitis and was allergic to pollen, dogs, cats, and soba. There was no relevant family medical history and no previous history of forceps delivery, major head injury, and infectious or valvular disease. On arrival at our hospital, his Glasgow Coma Scale score was 14 points (E3V5M6). Physical and neurological examination revealed no specific abnormal deficits. Laboratory blood tests also revealed no abnormalities. Plain CT of the brain showed SAH, localized in the right sylvian fissure, and evidence of skull fracture [Figure 1]. Subsequent CT angiography indicated an aneurysm of the right M2, which was not at a bifurcation site [Figure 1]. Magentic resonance (MR) angiography revealed that the aneurysm had a stalk-like narrow neck. A pseudoaneurysm was suspected on the basis of the atypical location and shape of the aneurysm, his age, and his medical history of Kawasaki disease. Preoperative echocardiography rejected the presence of bacterial endocarditis and other heart abnormalities. As far as we could examine, there were no other vascular abnormal findings other than the aneurysm described here including aneurysms of other locations.


Subarachnoid hemorrhage due to nonbranching aneurysm of the middle cerebral artery in a young adult with a history of Kawasaki disease.

Ishida A, Matsuo S, Kawamura S, Nishikawa T - Surg Neurol Int (2014)

Computed tomography (CT) of the patient at admission showed a thick subarachnoid hemorrhage (SAH) predominantly in the basal cistern and right Sylvian fissure (a). The SAH was spreading to the peripheral subarachnoid space and the brain seemed really tight (b). Three-dimensional CT angiography revealed an aneurysm arising from a distal point of the right middle cerebral artery bifurcation (c). Magnetic resonance (MR) angiography shows a clear image of the stalk-like and narrow aneurysm neck (d)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927094&req=5

Figure 1: Computed tomography (CT) of the patient at admission showed a thick subarachnoid hemorrhage (SAH) predominantly in the basal cistern and right Sylvian fissure (a). The SAH was spreading to the peripheral subarachnoid space and the brain seemed really tight (b). Three-dimensional CT angiography revealed an aneurysm arising from a distal point of the right middle cerebral artery bifurcation (c). Magnetic resonance (MR) angiography shows a clear image of the stalk-like and narrow aneurysm neck (d)
Mentions: A 20-year-old male experienced a sudden onset of headache, nausea, and vomiting. He was brought to a nearby hospital, where a head computed tomographic (CT) scan revealed SAH. He was immediately transferred to our hospital for emergency treatment. He had a history of Kawasaki disease, which was believed to be cured. He had severe atopic dermatitis and was allergic to pollen, dogs, cats, and soba. There was no relevant family medical history and no previous history of forceps delivery, major head injury, and infectious or valvular disease. On arrival at our hospital, his Glasgow Coma Scale score was 14 points (E3V5M6). Physical and neurological examination revealed no specific abnormal deficits. Laboratory blood tests also revealed no abnormalities. Plain CT of the brain showed SAH, localized in the right sylvian fissure, and evidence of skull fracture [Figure 1]. Subsequent CT angiography indicated an aneurysm of the right M2, which was not at a bifurcation site [Figure 1]. Magentic resonance (MR) angiography revealed that the aneurysm had a stalk-like narrow neck. A pseudoaneurysm was suspected on the basis of the atypical location and shape of the aneurysm, his age, and his medical history of Kawasaki disease. Preoperative echocardiography rejected the presence of bacterial endocarditis and other heart abnormalities. As far as we could examine, there were no other vascular abnormal findings other than the aneurysm described here including aneurysms of other locations.

Bottom Line: The incidence of subarachnoid hemorrhage (SAH) in young adults is relatively rare.Two weeks later, the patient was discharged without any apparent neurological deficit.We also performed a circumstantial pathological study on specimens obtained from the aneurysm wall.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.

ABSTRACT

Background: The incidence of subarachnoid hemorrhage (SAH) in young adults is relatively rare. Kawasaki disease is a systemic vasculopathy that is known to cause coronary artery aneurysms; however, its effect on cerebral arteries remains largely unclear.

Case description: We report the case of a 20-year-old male with a history of Kawasaki disease who presented with SAH caused by the rupture of a nonbranching middle cerebral artery aneurysm. This is the third report of SAH associated with Kawasaki disease. Preoperative echocardiography of the patient rejected the presence of bacterial endocarditis and other heart abnormalities. An emergency craniotomy and clip occlusion of the aneurysm was successfully performed without obstructing the parent artery. Two weeks later, the patient was discharged without any apparent neurological deficit. We also performed a circumstantial pathological study on specimens obtained from the aneurysm wall. Our histological findings suggest that the elastic lamina and tunica intima were completely destroyed during the acute vasculitis phase of Kawasaki disease, which possibly led to the aneurysmal formation.

Conclusions: Lack of active inflammatory changes and atherosclerotic lesions may explain the chronic feature of Kawasaki disease, not a typical aneurysmal formation.

No MeSH data available.


Related in: MedlinePlus