Highlights
- •Spinal subarachnoid hemorrhage and intradural spinal aneurysm are rare.
- •Intradural spinal aneurysm and subarachnoid hemorrhage have not been definitively documented radiologically in PAN
- •We present a patient with spinal subarachnoid hemorrhage originating from a spinal aneurysm who was later found to have PAN.
Abstract
Polyarteritis nodosa is characterized by presence of aneurysms in the renal, hepatic
and mesenteric vasculature, and less often by vascular abnormalities in the intracranial
compartment. Spinal subarachnoid hemorrhage is a rare phenomenon that can be associated
with inflammatory vasculopathies such as polyarteritis nodosa, but the link between
aneurysm formation and spinal subarachnoid hemorrhage in polyarteritis nodosa is unclear.
We describe a case of a patient with polyarteritis nodosa and spinal subarachnoid
hemorrhage following rupture of an aneurysm of the anterior spinal artery. Following
operative washout and decompression of the subarachnoid hemorrhage, spinal digital
subtraction angiography was performed and revealed intimal contour irregularities,
stenotic changes, and multiple small aneurysms in renal, hepatic, and bronchial arteries
and some proximal spinal arteries, and, most notably, a pseudoaneurysm of the anterior
spinal artery supplied directly by the artery of Adamkiewicz. Polyarteritis nodosa
was subsequently diagnosed in light of these findings. Though previous cases have
noted spinal subarachnoid hemorrhage in of the context of polyarteritis nodosa, we
found no previously documented case of a definitive aneurysm of the anterior spinal
artery in a case of polyarteritis nodosa documented on angiography. This case highlights
the potential importance of monitoring for aneurysms of the spinal vasculature in
cases of polyarteritis nodosa and in screening for vasculitides in cases of spinal
subarachnoid hemorrhage. Future studies are needed to describe patterns of the specific
anatomic localization and incidence of spinal artery aneurysms in polyarteritis nodosa.
Keywords
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References
- Neurologic presentations of systemic vasculitides.Neurol Clin. 2010; 28: 171-184https://doi.org/10.1016/j.ncl.2009.09.015
- Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French vasculitis study group database.Arthritis Rheum. 2010; 62: 616-626https://doi.org/10.1002/art.27240
- Polyarteritis nodosa.Rheum Dis Clin North Am. 2015; 41: 33-46https://doi.org/10.1016/j.rdc.2014.09.005
- An update of neurological manifestations of vasculitides and connective tissue diseases: a literature review.Einstein Sao Paulo Braz. 2015; 13: 627-635https://doi.org/10.1590/S1679-45082015RW3308
- Coil embolization of intracranial aneurysm in polyarteritis nodosa: a case report and review of the literature.Interv Neuroradiol. 2013; 19: 203-208https://doi.org/10.1177/159101991301900209
- Central nervous system vasculitis: still more questions than answers.Curr Neuropharmacol. 2011; 9: 437-448https://doi.org/10.2174/157015911796557920
- Central nervous system involvement of polyarteritis nodosa: a case report.Turk J Pediatr. 2001; 43: 146-150
- Neuroradiologic findings in polyarteritis nodosa.1996: 10
- Central nervous system polyarteritis nodosa.West J Med. 1990; 153: 553-556
- Collagen vascular disease: vasculitis, systemic lupus erythematosus, and rheumatoid arthritis.Semin Neurol. 1985; 5: 324-343https://doi.org/10.1055/s-2008-1063973
- Spinal subarachnoid hemorrhage in necrotizing vasculitis.J Rheumatol. 2008; 35: 180-182
- Spinal arterial aneurysm: case report.Neurosurgery. 1993; 33 ([discussion 129-130]): 125-129
- Spinal cord compression in polyarteritis nodosa.J R Soc Med. 1992; 85: 707-708
- Neurological complications of systemic vasculitis. A report of 2 cases.S Afr Med J. 1985; 68: 603-605
- Polyarteritis nodosa affecting the spinal cord arteries.Aust N Z J Med. 1983; 13: 287-289https://doi.org/10.1111/j.1445-5994.1983.tb04662.x
- Periarteritis nodosa as a source of subarachnoid hemorrhage and spinal cord compression: report of a case and review of the literature.J Neurosurg. 1957; 14: 608-616https://doi.org/10.3171/jns.1957.14.6.0608
- Spontaneous spinal subarachnoid haemorrhage.Q J Med. 1956; 25: 53-66
- A case of periarteritis nodosa of the central nervous system.J Ment Sci. 1950; 96: 470-475https://doi.org/10.1192/bjp.96.403.470
- Spinal aneurysms: clinicoradiological features and management paradigms.J Neurosurg Spine. 2013; : 34-48https://doi.org/10.3171/2013.3.SPINE121026
Maiti TK, Bir SC, Nanda A. Spinal subarachnoid hemorrhage and aneurysms. Handb Clin Neurol., vol. 143, Elsevier; 2017, p. 215–23. doi:https://doi.org/10.1016/B978-0-444-63640-9.00020-5.
- Spontaneous epidural hematoma in panarteritis nodosa.Rev Neurol (Paris). 1984; 140: 438-440
- Thrombosed aneurysm of the posterior inferior cerebellar artery and lateral medullary ischemia as the initial presentation of polyarteritis nodosa: case report and literature review.J Stroke Cerebrovasc Dis. 2018; 27: e168-e171https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.061
- The American college of rheumatology 1990 criteria for the classification of polyarteritis nodosa.Arthritis Rheum. 2010; 33: 1088-1093https://doi.org/10.1002/art.1780330805
- Spontaneous spinal subarachnoid hematoma of unknown pathogenesis: case reports.Neurosurgery. 1997; 41 ([discussion 693-694]): 691-693
- Spinal cord hemorrhage.J Stroke Cerebrovasc Dis. 2018; 27: 1435-1446https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.02.014
- Endovascular obliteration of a ruptured posterior spinal artery pseudoaneurysm: case report.J Neurosurg Spine. 2012; 17: 334-336https://doi.org/10.3171/2012.7.SPINE12123
- Comprehensive evaluation of diagnostic and treatment strategies for idiopathic spinal subarachnoid hemorrhage.J Stroke Cerebrovasc Dis. 2017; 26: 2840-2848https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.07.003
- Spinal artery aneurysms: clinical presentation, radiological findings and outcome.J Neuro Interventional Surg. 2018; 10: 644-648https://doi.org/10.1136/neurintsurg-2017-013687
- Multiple aneurysms of thoracic spinal cord arteries presenting with spinal infarction and subarachnoid hemorrhage: case report and literature review.Neurosurgery. 2012; 71: E1053-E1058https://doi.org/10.1227/NEU.0b013e3182647be4
- Dissecting aneurysm of the posterior spinal artery: case report and review of the literature.Neurosurgery. 2012; 71: E749-E756https://doi.org/10.1227/NEU.0b013e31825ea539
- Solitary ruptured aneurysm of the spinal artery of Adamkiewicz with subarachnoid hemorrhage.J Korean Neurosurg Soc. 2013; 54: 50https://doi.org/10.3340/jkns.2013.54.1.50
- Subarachnoid hemorrhage following posterior spinal artery aneurysm: a case report and review of the literature.Interv Neuroradiol. 2010; 16: 183-190https://doi.org/10.1177/159101991001600211
- Posterior spinal artery aneurysm presenting with leukocytoclastic vasculitis.J Cerebrovasc Endovasc Neurosurg. 2016; 18: 42https://doi.org/10.7461/jcen.2016.18.1.42
- Diagnosis and classification of polyarteritis nodosa.J Autoimmun. 2014; 48–49: 84-89https://doi.org/10.1016/j.jaut.2014.01.029
- Spontaneous retroperitoneal hemorrhage - a rare presentation of polyarteritis nodosa: role of angiography in diagnosis and management.Am J Interv Radiol. 2019; 3: 1-5https://doi.org/10.25259/AJIR-56-2018
- Vascular involvement of the central nervous system and systemic diseases: etiologies and MRI findings.Rheumatol Int. 2008; 28: 1229-1237https://doi.org/10.1007/s00296-008-0647-z
- Imaging spectrum of CNS vasculitis.Radio Graphics. 2014; 34: 873-894https://doi.org/10.1148/rg.344135028
- Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa: case report.J Neurosurg. 2002; 96: 132-134https://doi.org/10.3171/jns.2002.96.1.0132
- Polyarteritis nodosa: a clinical and angiographic analysis of 17 cases.Semin Arthritis Rheum. 1979; 8: 184-199https://doi.org/10.1016/S0049-0172(79)80007-4
- Ruptured intracranial aneurysms in pediatric polyarteritis nodosa.Neurol Med Chir (Tokyo). 2012; 52: 928-932https://doi.org/10.2176/nmc.52.928
- A case of polyarteritis nodosa with giant intracranial aneurysm.Rinsho Shinkeigaku. 2013; 53: 452-457
- Age-dependent degeneration of mature dentate gyrus granule cells following NMDA receptor ablation.Front Mol Neurosci. 2016; 8https://doi.org/10.3389/fnmol.2015.00087
- Periarteritis nodosa: a clinicopathologic report, with special reference to the central nervous system.Arch Neurol Psychiatry. 1942; 47: 828https://doi.org/10.1001/archneurpsyc.1942.02290050130012
- Subarachnoid spinal hemorrhage in a case of systemic lupus erythematosus.Arch Neurol. 1980; 37: 173-174https://doi.org/10.1001/archneur.1980.00500520071013
- Rupture of a spinal artery aneurysm attributable to exacerbated Sjögren syndrome.Neurosurgery. 2009; 64: E1010-E1011https://doi.org/10.1227/01.NEU.0000344002.21699.A3
- Spontaneous dissection of the extracranial vertebral artery with spinal subarachnoid haemorrhage in a patient with Behçet's disease.Neuroradiology. 1993; 35: 352-354https://doi.org/10.1007/BF00588368
- Treatment of polyarteritis nodosa and microscopic polyangiitis with poor prognosis factors: a prospective trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in sixty-five patients: treatment of PAN and MPA with poor prognosis factors.Arthritis Care Res. 2003; 49: 93-100https://doi.org/10.1002/art.10922
Article info
Publication history
Published online: April 17, 2019
Accepted:
April 16,
2019
Received in revised form:
April 9,
2019
Received:
February 28,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
