Subarachnoid Hemorrhage Caused by Ruptured Intracranial Fusiform Aneurysm Associated With Microscopic Polyangiitis
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- KIMURA Hidehito
- Department of Neurosurgery, Toyooka Public Hospital
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- AKUTSU Nobuyuki
- Department of Neurosurgery, Kobe University Graduate School of Medicine
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- SHIOMI Ryoji
- Department of Neurosurgery, Kobe University Graduate School of Medicine
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- KOHMURA Eiji
- Department of Neurosurgery, Kobe University Graduate School of Medicine
書誌事項
- タイトル別名
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- —Case Report—
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A 44-year-old woman with microscopic polyangiitis (MPA) presented with a ruptured cerebral aneurysm. She was admitted to our hospital for further examination of progressive renal failure. She was found lying on the ward floor. Computed tomography showed subarachnoid hemorrhage, and digital subtraction angiography revealed a saccular-like aneurysm arising from the right distal posterior inferior cerebellar artery (PICA) at the non-branching site. We performed neck clipping of the right distal PICA aneurysm, which recurred 5 days after the operation. Second angiography demonstrated a right distal PICA aneurysm just above the site of the clip. Therefore, we performed trapping of the affected lesion with emergent bypass of the contralateral occipital artery to the ipsilateral PICA. Her postoperative course was uneventful until she coughed up blood and had gross hematuria 3 days after the second surgery. Histological examination of a renal biopsy specimen revealed crescentic glomerulonephritis. MPA was diagnosed on the basis of the cardinal symptoms, including progressive glomerular nephritis and the lung abnormality, as well as the presence of myeloperoxidase-antineutrophil cytoplasmic antibodies. After intensive treatment, she was discharged for rehabilitation without neurological deficit. MPA commonly affects small-sized vessels mainly in the kidneys and lungs and may lead to crescentic glomerulonephritis and pulmonary hemorrhage. MPA is rarely associated with aneurysms of medium-sized muscular vessels. Cerebral aneurysm is extremely rare in patients with MPA, but rupture of an intracranial fusiform aneurysm can be lethal, so screening of the intracranial vessels should be performed by magnetic resonance imaging in patients with MPA.<br>
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 52 (7), 495-498, 2012
一般社団法人 日本脳神経外科学会
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詳細情報 詳細情報について
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- CRID
- 1390282680035251712
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- NII論文ID
- 10030694291
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- NII書誌ID
- AN00358613
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- COI
- 1:STN:280:DC%2BC38fksFWiug%3D%3D
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- ISSN
- 13498029
- 04708105
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- PubMed
- 22850498
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- 本文言語コード
- en
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- データソース種別
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- JaLC
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- PubMed
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