Polyarteritis Nodosa in Association with Subarachnoid Hemorrhage

Oomura, Masahiro; Yamawaki, Takemori; Terai, Tadashi; Shigeno, Koji

doi:10.2169/internalmedicine.45.1632

Cited by 27 publications

(19 citation statements)

References 11 publications

(9 reference statements)

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“…Only a few similar cases have been described (5). In the present patient, as in two previously reported cases, no micro-aneurysm was detected (6,7). The subarachnoid hemorrhage likely resulted from blood vessel weakening due to vasculitis, although a small, thrombosed, or spinal artery aneurysm could not be definitely excluded.…”

Section: Discussionsupporting

confidence: 72%

Polyarteritis Nodosa Associated with Essential Mixed Cryglobulinemia Revealed by Subarachnoid Hemorrhage

Taïeb¹,

Renard²,

Briere

et al. 2011

Intern. Med.

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Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis mediated by intravascular deposition of immune complexes. We report a 55-year-old man with PAN revealed by CNS vasculitis with subarachnoid hemorrhage and brainstem vasogenic oedema, associated with essential mixed cryoglobulinemia. In spite of aggressive treatment (steroids and cyclophosphamide), the patient became tetraplegic. A pathophysiological relationship between cryoglobulin and PAN can be suspected. Mixed cryoglobulinemia may trigger vasculitis with PAN features, possibly explaining the lack of treatment response.

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Section: Discussionsupporting

confidence: 72%

Polyarteritis Nodosa Associated with Essential Mixed Cryglobulinemia Revealed by Subarachnoid Hemorrhage

Taïeb¹,

Renard²,

Briere

et al. 2011

Intern. Med.

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“…4,[12][13][14]17,21,23) Peripheral artery aneurysms were observed in five cases. 9,12,14,17) Thus, intracranial aneurysm in PAN seems to occur more frequently in the posterior circulation, peripheral location, and as multiple lesions compared with usual saccular aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, the importance of early detection and appropriate treatment have been stressed for intracranial aneurysms formed in PAN patients. 12,13,22) We recommend that follow-up neurovascular imaging should be performed at regular intervals, starting early, for patients with PAN with a long-lasting history.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Intracranial Aneurysms in Pediatric Polyarteritis Nodosa

Toyoda

Tsutsumi

Hirao

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Polyarteritis nodosa (PAN) is a rare, systemic necrotizing vasculitis of small and medium size arteries that leads to aneurysms in various organs. Aneurysms associated with PAN are common in visceral arteries, however, intracranial aneurysms are rare, especially in childhood. A pediatric patient with PAN developed serial hemorrhagic strokes from a ruptured superior cerebellar artery aneurysm (subarachnoid hemorrhage) and a de novo aneurysm of the frontoorbital artery (intracerebral hemorrhage) after 9 months. Patients with PAN who present with intracranial aneurysms are candidates for intervention even if the aneurysm is unruptured and still small, and close observation is needed to detect de novo aneurysms in patients with chronic history of PAN.

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“…Although aneurysmal formation in visceral arteries is common in patients with PAN, aneurysms are rarely found in intracranial arteries [26]. Involvement of the central nervous system is less common and tends to occur later in the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

A case of MPO-ANCA-positive polyarteritis nodosa complicated by exudative otitis media, mononeuritis multiplex, and acute renal failure

et al. 2011

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In December 2008, a 69-year-old Japanese woman was admitted to the Department of Otorhinolaryngology because of hearing impairment due to bilateral exudative otitis media, and was discharged without complete recovery despite conventional treatment. Two weeks later, she was readmitted for worsened deafness, numbness, gait disturbance, and general fatigue. She was referred to our department for general investigation. On admission, laboratory examination revealed severe inflammatory signs and active nephritic urinary sediments. Cranial computed tomography (CT) revealed progressive exudative otitis media and sinusitis. Initially, Wegener's granulomatosis was suspected. Nasal cavity biopsy, however, showed no granuloma formation or vasculitis. Serology revealed high titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA), suggestive of microscopic polyangitis (MPA). However, contrast CT identified stenosis of a celiac artery, and renal biopsy showed tubulointerstitial changes with minor glomerular abnormalities. Therefore, polyarteritis nodosa (PAN) was suspected and treatment with intravenous methylprednisolone was initiated. However, a lacunar infarct developed followed by cerebral hemorrhage, and the patient died 19 days after readmission. Autopsy revealed fibrinoid necrosis, neutrophilic infiltration, and giant cell reaction in small to medium-sized arteries in multiple organs. These findings led to diagnosis of systemic vasculitis anatomically compatible with PAN. This was a rare case of a patient with MPO-ANCA-positive PAN who may have developed bilateral exudative otitis media and hearing loss as the initial manifestation of PAN.

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Polyarteritis Nodosa in Association with Subarachnoid Hemorrhage

Abstract: We report a 65-year-old

Cited by 27 publications

References 11 publications

Polyarteritis Nodosa Associated with Essential Mixed Cryglobulinemia Revealed by Subarachnoid Hemorrhage

Polyarteritis Nodosa Associated with Essential Mixed Cryglobulinemia Revealed by Subarachnoid Hemorrhage

Ruptured Intracranial Aneurysms in Pediatric Polyarteritis Nodosa

A case of MPO-ANCA-positive polyarteritis nodosa complicated by exudative otitis media, mononeuritis multiplex, and acute renal failure

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