Ruptured Intracranial Aneurysms in Pediatric Polyarteritis Nodosa

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.

[1]  J. Jorizzo,et al.  Small‐vessel vasculitis , 2012, Dermatologic therapy.

[2]  M. Han,et al.  ENDOVASCULAR TREATMENT OF RUPTURED ANEURYSMS OR PSEUDOANEURYSMS ON THE COLLATERAL VESSELS IN PATIENTS WITH MOYAMOYA DISEASE , 2009, Neurosurgery.

[3]  U. Limaye,et al.  Endovascular management of ruptured cerebral mycotic aneurysms , 2008, British journal of neurosurgery.

[4]  R. Sellar,et al.  The incidence of microaneurysms in polyarteritis nodosa , 2007, CardioVascular and Interventional Radiology.

[5]  P Woo,et al.  EULAR/PReS endorsed consensus criteria* for the classification of childhood vasculitides , 2005, Annals of the rheumatic diseases.

[6]  H. Naritomi,et al.  Polyarteritis nodosa in association with subarachnoid hemorrhage. , 2006, Internal medicine.

[7]  K. Fujii,et al.  Repeat angiography and magnetic resonance imaging (MRI) of dissecting aneurysms of the intracranial vertebral artery , 1993, Acta Neurochirurgica.

[8]  A. Sarkar,et al.  Distal anterior inferior cerebellar artery aneurysm masquerading as a cerebellopontine angle tumor: case report and review of literature. , 2004, Skull base : official journal of North American Skull Base Society ... [et al.].

[9]  Barbara C. Thompson,et al.  Subarachnoid hemorrhages in vasculitis. , 2003, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[10]  K. Iihara,et al.  Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa. Case report. , 2002, Journal of neurosurgery.

[11]  N. Yunten,et al.  Multiple intracranial aneurysms in polyarteritis nodosa: MRI and angiography , 1999, Neuroradiology.

[12]  Munn Ej,et al.  Polyarteritis with symptomatic intracerebral aneurysms at initial presentation. , 1998 .

[13]  D. C. Diffin,et al.  Polyarteritis with symptomatic intracerebral aneurysms at initial presentation. , 1998, The Journal of rheumatology.

[14]  D. Hauri,et al.  Spontaneous perirenal hemorrhage after rupture of an aneurysm in case of polyarteritis nodosa along with anuric renal failure. Case report and review of the literature. , 1997, Urologia internationalis.

[15]  J. Provenzale,et al.  Neuroradiologic findings in polyarteritis nodosa. , 1996, AJNR. American journal of neuroradiology.

[16]  M. Powell,et al.  Stroke-induced cardiovascular changes: a rare cause of death from polyarteritis nodosa. , 1995, British journal of neurosurgery.

[17]  R J Falk,et al.  Nomenclature of systemic vasculitides. Proposal of an international consensus conference. , 1994, Arthritis and rheumatism.

[18]  R. Wernick,et al.  Spontaneous rupture of a renal artery aneurysm in polyarteritis nodosa: critical review of the literature and report of a case. , 1989, The American journal of medicine.

[19]  T. Cupps,et al.  Neurological complications of vasculitis , 1983, Annals of neurology.

[20]  A. Fauci,et al.  Neurologic manifestations of systemic vasculitis. A retrospective and prospective study of the clinicopathologic features and responses to therapy in 25 patients. , 1981, American Journal of Medicine.

[21]  D J Allison,et al.  Polyarteritis nodosa: a clinical and angiographic analysis of 17 cases. , 1979, Seminars in arthritis and rheumatism.

[22]  E. Leonhardt,et al.  Angiographic and clinicophysiologic investigation of a case of polyarteritis nodosa. , 1972, The American journal of medicine.

[23]  P. Borrie.  Polyarteritis , 1970 .

[24]  G. Gherardi,et al.  Localized dissecting hemorrhage and arteritis. Renal and cerebral manifestations. , 1967, JAMA.

[25]  V. Summers.  The nervous manifestations of periarteritis nodosa. , 1950, Lancet.