[Markedly dilated cervical carotid arteries in a patient with a ruptured aneurysm of the anterior communicating artery: a case report].
We reported a case of ruptured aneurysm of the anterior communicating artery with marked dilatation of bilateral cervical carotid arteries. A 38 year old female suffered a subarachnoid hemorrhage. Angiography on admission revealed markedly dilated cervical carotid arteries with smooth lumen and a few segmental areas with mild constrictions in their entire course up to the carotid canals (their maximal sagittal diameters exceeded those of a cervical vertebral body). A saccular aneurysm was also seen at the junction of right A1, A2, and Acom. External carotid arteries were normal in size. Vertebral arteries were not examined because of failures of selective cannulation. The patient was operated upon and trapping of Acom was performed. During the operation, no definite arteriosclerotic changes were identified in the intracranial arteries. Histopathological examination of the surgical specimens revealed marked hyperplasia of the smooth muscle of the tunica media with intact internal elastic lamina both in a superficial temporal artery and a middle meningeal artery. During the operation, pneumothorax developed due to the rupture of bullae in the right lung. Past history of this patient disclosed hypertension noted a few years previously, and frequent severe bruises following minor trauma. Repeated angiography performed three months after the operation disclosed unchanged dilatation of the cervical carotid arteries as well as mild intraluminal irregularities in the proximal one third of the left renal artery. This patient died of pneumonia one year after the operation, but autopsy was not permitted. Possible diagnosis of this patient was discussed, with particular emphasis on fibromuscular dysplasia and Ehlers-Danlos type IV (arterial, ecchymotic, or Sack-Barabas type).(ABSTRACT TRUNCATED AT 250 WORDS)
Nakai
H
H
Department of Neurosurgery, Kitami Kobayashi Hospital.
Kawata
Y
Y
Tomabechi
M
M
Aizawa
S
S
Ohgami
S
S
Yonemasu
Y
Y
Muraoka
S
S
D000328:Adult; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D004108:Dilatation, Pathologic; D004535:Ehlers-Danlos Syndrome / Q000150:complications; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D011859:Radiography; D012422:Rupture, Spontaneous