title: Rapid aneurysm growth and rupture in systemic lupus erythematosus.
abstract: BACKGROUND
  Subarachnoid hemorrhage (SAH) due to intracranial aneurysm rupture is a major neurosurgical emergency associated with significant morbidity and mortality. Rapid aneurysm growth is associated with rupture. Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder whose complications can include cerebral vasculitis and vasculopathy. Intracranial aneurysms are not known to occur more frequently in SLE patients than the general population; however, aneurysm growth rates have not been studied in SLE.
  
  
  METHODS
  We present a 43-year-old female with SLE on prednisone, hydroxychloroquine, and azathioprine with moderate disease activity who presented with severe, acute-onset headache and was found to have Hunt and Hess grade II SAH due to rupture of an 8 mm saccular anterior communicating artery (ACoA) aneurysm. The patient developed severe vasospasm, re-ruptured, and was taken for angiography and embolization, which was challenging due to a high degree of vasospasm and arterial stenosis. Review of imaging from less than 2 years prior demonstrated a normal ACoA complex without evidence of an aneurysm.
  
  
  CONCLUSIONS
  We review the literature and discuss the risk factors and pathophysiology of rapid aneurysm growth and rupture, as well as the pathologic vascular changes associated with SLE. Although SLE patients do not develop intracranial aneurysm at an increased rate, these changes may predispose them to higher incidence of growth and rupture. This possibility-coupled with increased morbidity and mortality of SAH in SLE-suggests that SAH should be considered in SLE patients presenting with headache, and advocates for more aggressive treatment of SLE patients with unruptured aneurysms.
authors: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors: Christopher S
authors: CS
authors: Graffeo
authors: Department of Neurosurgery, New York University School of Medicine, New York, USA.
authors: Omar
authors: O
authors: Tanweer
authors: Department of Division of Rheumatology, New York University School of Medicine, New York, USA.
authors: Cesar Fors
authors: CF
authors: Nieves
authors: Department of Division of Rheumatology, New York University School of Medicine, New York, USA.
authors: H Michael
authors: HM
authors: Belmont
authors: Department of Division of Rheumatology, New York University School of Medicine, New York, USA.
authors: Peter M
authors: PM
authors: Izmirly
authors: Department of Radiology, New York University School of Medicine, New York, USA ; Department of Neurology, New York University School of Medicine, New York, USA.
authors: Tibor
authors: T
authors: Becske
authors: Department of Neurosurgery, New York University School of Medicine, New York, USA.
authors: Paul P
authors: PP
authors: Huang
keywords: Aneurysm growth; intracranial aneurysms; subarachnoid hemorrhage; systemic lupus erythematosus
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