Coil Embolization of Intracranial Aneurysm in Polyarteritis Nodosa A Case Report and Review of the Literature

Polyarteritis nodosa (PAN) is a rare multisystem disease characterized by systemic necrotizing arteritis of small and medium size arteries. The skin, joints, kidneys, gastrointestinal tract and peripheral nerves are most commonly involved. Although aneurysms are commonly seen in the visceral vessels...

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Published in:	Interventional neuroradiology Vol. 19; no. 2; pp. 203 - 208
Main Authors:	Gupta, V., Chinchure, S.D., Goel, G., Jha, A.N., Malviya, S., Gupta, R.
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-06-2013 Centauro S.r.l
Subjects:	Adult Blood Vessel Prosthesis Embolization, Therapeutic - instrumentation Female Humans Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - etiology Intracranial Aneurysm - surgery Mechanical Thrombolysis - instrumentation Original Polyarteritis Nodosa - complications Polyarteritis Nodosa - diagnostic imaging Polyarteritis Nodosa - surgery Radiography Treatment Outcome embolization aneurysm polyarteritis nodosa
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Summary:	Polyarteritis nodosa (PAN) is a rare multisystem disease characterized by systemic necrotizing arteritis of small and medium size arteries. The skin, joints, kidneys, gastrointestinal tract and peripheral nerves are most commonly involved. Although aneurysms are commonly seen in the visceral vessels, intracranial aneurysms are rare with 15 reported cases. The intracranial aneurysms are usually multiple and located in supra- as well as infra-tentorial compartments. Most of the cases presented with subarachnoid or parenchymal hemorrhage. The aneurysms were usually small, although large cavernous aneurysms were reported in one case. Treatment guidelines are not clear regarding the management of these cases. Most patients were treated conservatively by medical management with surgical excision performed in only two cases and coiling done in one patient with cavernous aneurysms. Repeat hemorrhages or re-bleed in spite of medical treatment have also been reported. We describe the case of a 22-year-old woman, a known case of PAN who presented with subarachnoid hemorrhage. Cerebral angiogram showed a ruptured right middle cerebral artery bifurcation aneurysm along with unruptured left middle cerebral, right posterior communicating and left posterior inferior cerebellar artery aneurysms. Her previous abdominal angiogram had revealed multiple aneurysms in visceral arteries. Successful coil embolization of the ruptured right MCA bifurcation aneurysm was performed with preservation of the parent vessel. The patient made a complete recovery and was placed on medical treatment for PAN. Follow-up MR angiography at three months revealed stable occlusion of the embolized aneurysm with no change in the unruptured aneurysms. Although rare, PAN can be associated with intracranial aneurysms which can cause subarachnoid or parenchymal hemorrhage. Selected cases can be treated safely by coil embolization.
Bibliography:	ObjectType-Case Study-3 SourceType-Scholarly Journals-1 content type line 23 ObjectType-Review-1 ObjectType-Feature-5 ObjectType-Report-2 ObjectType-Article-4 Dr Swati D Chinchure - Institute of Neurosciences - Medanta - The Medicity Hospital - Sector 38, Gurgaon - Gurgaon 122018 India - E-mail: swatichinchure@yahoo.com
ISSN:	1591-0199 2385-2011
DOI:	10.1177/159101991301900209