[A case of systemic lupus erythematosus with subarachnoid hemorrhage due to ruptured aneurysm].
A case of systemic lupus erythematosus (SLE) with subarachnoid hemorrhage due to a ruptured intracranial aneurysm is reported. A 31-year-old woman who had been treated with steroid for SLE was admitted to our department with severe headache, and nausea. CT scan showed subarachnoid hemorrhage and the left carotid angiogram revealed a small aneurysm at the supraclinoid portion of the left internal carotid artery. She had no neurological deficit. Hematological examination on admission showed disseminated intravascular coagulation (DIC), therefore, we decided to perform an intentionally delayed operation. In the meantime we treated the patient for DIC with FOY and methylprednisolone. The operation was performed after two weeks, when DIC had been eliminated completely. Postoperative hematological examination showed severe thrombocytopenia. We considered that SLE had come to the fore again, so we used Danazol in company with FOY and steroid. It seemed that Danazol was very effective for her. She was discharged about two months after admission with no problem. Cerebral apoplexy, such as cerebral infarction and cerebral hemorrhage, has often been seen in SLE, but subarachnoid hemorrhage due to a ruptured aneurysm is very rare. We could find only five reports of this phenomenon. Their prognoses were all, unfortunately, poor. It should be born in mind for therapy that a patient in SLE has a tendency to bleed. It seems that repeated hematological examinations and quick and proper management are important. We think that the aneurysmal formation in SLE is due to lupus vasculitis or the fragility of blood vessels due to a long use of Steroid.
Department of Neurosurgery, Faculty of Medicine, Kagoshima University, Japan.
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Kodama
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Asakura
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Kadota
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Kasamo
D000328:Adult; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery; D002343:Carotid Artery, Internal; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000601:surgery