Aneurysmal subarachnoid hemorrhage in a patient with Wegener?s granulomatosis

Abstract

A 34-year-old Japanese man admitted to hospital with pneumonia had previously undergone surgery for paranasal sinusitis and also for the clipping of an aneurysm at the origin of the anterior choroidal artery after subarachnoid hemorrhage. Laboratory tests performed at the present admission showed renal insufficiency and serological findings of raised proteinase 3 antineutrophil cytoplasmic antibody level. A renal biopsy was performed that showed diffuse necrotizing glomerulonephritis with fibrocellular crescents. The diagnosis of Wegener's granulomatosis(WG) was confirmed on the basis of the clinical picture, laboratory findings, and biopsies of renal tissues. The disease responded to prednisolone and cyclophosphamide. The association of WG with a ruptured intracranial aneurysm is rare and has not previously been confirmed.

Treatment of an Unruptured Fusiform Aneurysm of the Internal Carotid Artery Associated With Wegener's Granulomatosis by Endovascular Balloon Occlusion

“…11) The present case of an unruptured fusiform aneurysm in Wegener's granulomatosis was treated by endovascular balloon occlusion.…”

“…Intracranial aneurysms in Wegener's granulomatosis are extremely rare, and only one case of a clipping operation of a ruptured aneurysm has been reported. 11) We treated a case of unruptured, Wegener's granulomatosis-induced intracranial aneurysm by proximal endovascular occlusion, and describe the 4-year postoperative follow-up findings.…”

Wegener's granulomatosis presenting as an abdominal aortic aneurysm: a case report

“…A combination of cyclophosphamide and prednisone is effective [10] in > 90% with severe disease. Methotrexate and prednisone are useful when the disease spares the kidneys.…”

Atypical Manifestations of Granulomatosis with Polyangiitis: The Diagnostic Challenge for Pulmonologists

“…Larger brain arteries are involved extremely rarely [39]. The unique case of GPA with paranasal sinuses, pulmonary and renal manifestations, and concomitant intracranial aneurysm of the anterior choroidal artery, complicated by rupture and subarachnoid hemorrhage, has been reported by Takei et al [39]. Necrotizing vasculitis was also a pathogenic mechanism of ischemic infarction in few case reports [40][41].…”

“…Case reports on cranial neuropathies in GPA prove the true diagnostics difficulties, because sometimes the diagnosis is possible only when lung and/or renal extension of GPA follows its initial neurological manifestation [36--38]. Larger brain arteries are involved extremely rarely [39]. The unique case of GPA with paranasal sinuses, pulmonary and renal manifestations, and concomitant intracranial aneurysm of the anterior choroidal artery, complicated by rupture and subarachnoid hemorrhage, has been reported by Takei et al [39].…”