Onyx Embolization of Ruptured Intracranial Aneurysm Associated with Behçet's Disease

Abstract

Introduction. Intracranial aneurysms associated with Behçet's disease (BD) are a rare occurrence. They are fragile, thin-walled pseudoaneurysms, which have high tendency to rupture and present a therapeutic challenge. Case Presentation. We report a 26-year-old male with BD presented with subarachnoid hemorrhage due to ruptured middle cerebral artery aneurysm. Additionally, two unruptured aneurysms were identified. He underwent endovascular embolization using Onyx with successful obliteration of the ruptured aneurysm. Medical therapy resulted in regression of one and resolution of the other aneurysms. Conclusion. We describe the first report of the application of Onyx for obliteration of ruptured cerebral aneurysm in BD as a feasible and safe therapeutic option for patients who are not candidates for other techniques.

Multiple Intracranial Aneurysms Associated with Behçet's Disease

“…All 24 cases, in addition to our case, were summarized in Table 1 . 2) 3) 6) 7) 9) 10) 11) 13) 16) 17) …”

Case of Behçet's disease complicated by oculomotor nerve palsy associated with internal carotid artery‐posterior communicating artery aneurysm

“…Conversely, cerebral arterial aneurysm is reported to be rare. The majority of patients present with ruptured aneurysm, resulting in subarachnoid hemorrhage . Furthermore, some have multiple aneurysms predominately involving the anterior circulation, particularly the middle cerebral artery .…”

“…4 Furthermore, some have multiple aneurysms predominately involving the anterior circulation, particularly the middle cerebral artery. 4 Male sex and a positive pathergy test may be risk factors for pulmonary arterial aneurysms 8 and may lead to other arterial aneurysms, including cerebral aneurysm in patients with vasculo-BD. Vasculo-BD is frequently experienced in BD patients with disease lasting over 10 years, 9 and the first vascular lesion increases the risk for other vascular lesions and progressive multifocal vessel-related complications.…”

“…The reported incidence of vascular complications in BD patients is variable, ranging 3.6–24%, with large vessel involvement in 1.3–2.2% of all BD patients . The involvement of intracranial vessels is extremely rare, with an overall incidence of 0.3–1.5% …”

“…3 The involvement of intracranial vessels is extremely rare, with an overall incidence of 0.3-1.5%. 4 Vasculo-BD occurs when BD affects the arteries, veins and blood vessels, and it can present with three major manifestations: venous occlusion, arterial occlusion and aneurysm formation. Aorta and pulmonary artery aneurysm formations in vasculo-BD are the most frequently seen manifestations and are among the most life-threatening complications.…”