Fulminant Vasculitis Associated with Extracranial Dissections and Occlusion, Ischemic Strokes, and Aneurysm Rupture: Case Report and Review of the Literature.
BACKGROUND
Central nervous system vasculitis has multiple presentations, including stroke, seizures, cranial nerve palsies, and encephalopathy.


METHODS
We present the case of an unresponsive 45-year-old woman with vasculitis associated with fulminant intracranial vessel dissection and occlusion with ischemic strokes and subarachnoid hemorrhage secondary to aneurysm rupture. Imaging studies demonstrated both ischemic and hemorrhagic strokes. She had a ruptured right internal carotid artery dorsal variant aneurysm, right vertebral artery dissection with occlusion and posterior inferior cerebellar artery infarct, left vertebral artery dissection, and severe vasculitis involving intracranial and extracranial vessels. She initially was treated for her vasculitis with high-dose steroids followed by clip wrapping of the dorsal variant aneurysm. Unfortunately, her surgery was complicated by intraprocedural rupture, and the patient died during her hospitalization.


CONCLUSIONS
Fulminant central nervous system vasculitis can occur with critical vascular anomalies that require emergent intervention and should be part of the differential diagnosis of patients presenting with these multiple vascular pathologies.
Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Osama
O
Jamil
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Philipp
P
Taussky
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Richard H
RH
Schmidt
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
Min S
MS
Park
D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000072226:Computed Tomography Angiography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D015898:Tomography Scanners, X-Ray Computed; D014657:Vasculitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery
Cerebral aneurysm; Dissections; Stroke; Vasculitis