title: Segmental Arterial Mediolysis Involving Both Vertebral and Middle Colic Arteries Leading to Subarachnoid and Intraperitoneal Hemorrhage.
abstract: BACKGROUND
  Segmental arterial mediolysis (SAM) is not yet well known in the neurosurgical field, even though it has become an increasingly recognized pathology in arterial dissection.
  
  
  METHODS
  A case of SAM presented as subarachnoid hemorrhage (SAH) due to a dissecting aneurysm of the left intracranial vertebral artery (VA), which extended from the proximal VA union to the distal portion of the left posterior inferior cerebellar artery. The lesion was successfully embolized by an endovascular technique. However, subsequent intraperitoneal hemorrhage due to rupture of a fusiform aneurysm of the middle colic artery prompted surgical treatments. The features of the extirpated visceral vascular lesion were compatible with the diagnosis of SAM based on histopathologic examinations.
  
  
  CONCLUSIONS
  It is very important that SAM is recognized as a systemic disease that affects the central nervous system, visceral arteries, and coronary arteries. The possibility of SAM should always be considered, particularly in patients with ruptured VA dissection-which is nowadays treated by endovascular techniques-since concomitantly involved visceral arteries may cause unexpected hemorrhagic complications other than SAH.
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan. Electronic address: shinoda.narihide@shinkohp.or.jp.
authors.forename: Narihide
authors.initials: N
authors.lastname: Shinoda
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirai
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Mikami
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Bando
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shimo
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kuroyama
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kuramoto
authors.affiliation: Department of Neurosurgery, Shinko Hospital, Kobe, Hyogo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ueno
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010532:Peritoneal Diseases / Q000209:etiology* / Q000517:prevention & control*; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*
keywords: Abnormal visceral arteries; Intraperitoneal hemorrhage; Segmental arterial mediolysis; Subarachnoid hemorrhage; Systemic multiple aneurysms; Vertebral artery