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
- Daniel L Cooke1,
- Karl M Meisel2,
- Warren T Kim1,
- Charles E Stout1,
- Van V Halbach1,
- Christopher F Dowd1,
- Randall T Higashida1
- 1Department of Radiology, UCSF Medical Center, San Francisco, California, USA
- 2Department of Neurology, UCSF Medical Center, San Francisco, California, USA
- Correspondence to Dr D Cooke, Department of Radiology and Biomedical Imaging, University California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143-0628, USA;
Contributors All authors helped in the clinical care of the patient as well as construction and review of the manuscript.
- Received 24 February 2012
- Revised 14 May 2012
- Accepted 15 May 2012
- Published Online First 12 June 2012
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.
Competing interests None.
Patient consent Not obtained.
Provenance and peer review Not commissioned; externally peer reviewed.