Ruptured Intracranial Aneurysms in Pediatric Polyarteritis Nodosa

Toyoda, Keisuke; Tsutsumi, Keisuke; Hirao, Tomohito; Ono, Tomonori; Takahata, Hideaki; Toda, Keisuke; Baba, Hiroshi; Ito, Masahiro; Yonekura, Masahiro

doi:10.2176/nmc.52.928

Cited by 12 publications

(11 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Large (>1.5 cm) PAN-associated IAs, such as in this case, are extremely rare,2 9 and this report represents the only giant (>2.5 cm) IA in the literature. IAs most commonly present with intracranial hemorrhage (SAH or, less frequently, ICH) 4 5 18 19. Ischemic strokes may occur, including retinal infarctions2 and a lateral medullary syndrome 6.…”

Section: Discussionmentioning

confidence: 99%

Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case

Santos

Kaderali

Spears³

et al. 2015

BMJ Case Reports

View full text Add to dashboard Cite

Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis.

show abstract

Section: Discussionmentioning

confidence: 99%

Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case

Santos

Kaderali

Spears³

et al. 2015

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…[176][177][178] Toyoda et al report the use of vascular intervention by way of aneurysm trapping for ruptured intracranial aneurysms in one pediatric patient. 179 In adult studies, Hashimoto et al demonstrated potential benefit with the use of plasmapheresis in addition to corticosteroids and cyclophosphamide in a case series, though Guillevin et al demonstrated no added benefit of plasmapheresis. 3,29,180 PAN is frequently relapsing and progressive despite treatment, and CNS involvement conveys a worse prognosis.…”

Section: Diagnosismentioning

confidence: 99%

Central Nervous System Involvement in Pediatric Systemic Autoimmune Diseases

Stanton

Knight

2017

J Pediatr Neurol

View full text Add to dashboard Cite

Central nervous system (CNS) involvement occurs in many pediatric systemic autoimmune diseases. These manifestations are often associated with increased morbidity and mortality and can have adverse long-term effects on neurodevelopmental, health-related, and quality-of-life outcomes. In this review, we summarize the existing literature on CNS involvement in pediatric systemic autoimmune diseases, compare diagnostic findings, and describe current treatments. CNS manifestations of pediatric systemic autoimmune disease present diagnostic and management challenges due to their relatively rare occurrence in children, the difficulty in confirming direct CNS involvement as opposed to secondary symptoms occurring as a consequence of systemic inflammation, and the need to define treatment strategies effective for CNS involvement.

show abstract

“…[13][14][15][16] • Detachable balloons (Balt, Goldballoons, Balt Extrusion, Montmorency, France) are not currently Food and Drug Administration (FDA) approved, but are available in most countries, as of August 2014. • Care must be used when employing detachable balloons in the cerebral circulation, as they have the potential risk of spontaneously deflating over time or rupturing once deployed, and then embolizing into the distal arterial circulation.…”

Section: Mechanical Devicesmentioning

confidence: 99%