Serial angiographic appearance of segmental arterial mediolysis manifesting as vertebral, internal mammary and intra-abdominal visceral artery aneurysms in a patient presenting with subarachnoid hemorrhage and review of the literature.
Segmental arterial mediolysis (SAM) is a rare, non-inflammatory, non-atherosclerotic vasculopathy typically affecting the abdominal arteries although it may also affect the great vessels and cerebral vasculature. Diseased vessels manifest with aneurysms and/or dissections, often presenting clinically with catastrophic thromboembolic injury and less frequently with subarachnoid hemorrhage (SAH). The etiology of SAM remains indeterminate although there is evidence it may be an endogenous pathological response to vasospasm. The SAM literature is reviewed and a case of SAH related to a ruptured dissecting-type vertebral artery aneurysm is described. In addition to furthering awareness of SAM, this unique case offers insight into the acute phase of the disease and the potential role of vasospastic induction.
Department of Radiology and Biomedical Imaging, University of California-San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA. daniel.cooke@ucsf.edu
Daniel L
DL
Cooke
Karl M
KM
Meisel
Warren T
WT
Kim
Charles E
CE
Stout
Van V
VV
Halbach
Christopher F
CF
Dowd
Randall T
RT
Higashida
D015901:Angiography, Digital Subtraction; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D050781:Transcranial Magnetic Stimulation; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000209:etiology; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging*