Neurological manifestations of polyarteritis nodosa: a tour of the neuroaxis by case series

Abstract Background Heterogenous central nervous system (CNS) neurologic manifestations of polyarteritis nodosa (PAN) are underrecognized. We review three cases of patients with PAN that illustrate a range of nervous system pathology, including the classical mononeuritis multiplex as well as uncommon brain and spinal cord vascular manifestations. Case presentation Case 1 presented with mononeuritis multiplex and characteristic skin findings. Case 2 presented with thunderclap headache and myelopathy due to spinal artery aneurysm rupture. Both patients experienced disease remission upon treatment. Case 3 presented with headache and bulbar symptoms due to partially thrombosed intracranial aneurysms, followed by systemic manifestations related to visceral aneurysms. She demonstrated clinical improvement with treatment, was lost to follow-up, then clinically deteriorated and entered hospice care. Conclusions Although the peripheral manifestations of PAN are well-known, PAN association with CNS neurovascular disease is relatively underappreciated. Clinician awareness of the spectrum of neurologic disease is required to reduce diagnostic delay and promote prompt diagnosis and treatment with immunosuppressants.

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Association between posterior fossa arteriovenous malformations and prenidal aneurysm rupture: potential impact on management

Neurosurgical FOCUS ◽

10.3171/2014.6.focus14219 ◽

2014 ◽

Vol 37 (3) ◽

pp. E4 ◽

Cited By ~ 16

Author(s):

Evgueni Kouznetsov ◽

Alain Weill ◽

Jimmy S. Ghostine ◽

Jean-Christophe Gentric ◽

Jean Raymond ◽

...

Keyword(s):

Posterior Fossa ◽

Arteriovenous Malformations ◽

Case Series ◽

Aneurysm Rupture ◽

Modified Rankin Scale ◽

Feeding Artery ◽

Potential Impact ◽

Arterial Aneurysms ◽

Lost To Follow Up

Object In patients with posterior fossa arteriovenous malformations (AVMs) who present with hemorrhage, feeding artery aneurysms are often the source of bleeding. The aim of this study was to evaluate the relative proportions of cases of infra- and supratentorial AVMs in which patients presented with prenidal aneurysm rupture. The management and outcome of 9 cases of posterior fossa AVMs associated with prenidal aneurysm rupture are presented. Methods The authors retrospectively reviewed 233 consecutive AVM cases involving patients treated at their institution between April 2001 and August 2012. Patients with a prenidal aneurysm as the cause of the hemorrhage were identified. The frequencies of prenidal aneurysm-related ruptures were compared in cases of supra- and infratentorial AVMs. Management and clinical outcome (modified Rankin Scale [mRS] score) of patients with posterior fossa AVMs treated for ruptured prenidal aneurysms were recorded. Results Of 233 AVMs, 25 (11%) were in the posterior fossa, and in 22 (88%) of these cases, the patients presented with hemorrhage, including 9 patients (41%) who presented with hemorrhage due to prenidal aneurysm rupture. Of 208 patients with supratentorial AVMs, 107 (51%) presented with hemorrhage, including 5 patients (4.7%) in whom the hemorrhage was associated with a prenidal aneurysm (p < 0.01). All 9 patients with posterior fossa AVMs and prenidal aneurysm rupture were treated with early embolization of the offending aneurysm. There was no early rebleeding or clinical complication related to this approach. At the end of follow-up (mean 46.8 months), 2 patients had an mRS score of 0, 1 had a score of 1, 3 had a score of 2, 2 patients were dead (mRS score of 6), and 1 patient was lost to follow-up. Conclusions Posterior fossa AVM hemorrhages are frequently associated with prenidal arterial aneurysms. Urgent endovascular treatment of the aneurysm was effective in this case series.

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Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa

Journal of Neurosurgery ◽

10.3171/jns.2002.96.1.0132 ◽

2002 ◽

Vol 96 (1) ◽

pp. 132-134 ◽

Cited By ~ 29

Author(s):

Jun C. Takahashi ◽

Nobuyuki Sakai ◽

Koji Iihara ◽

Hideki Sakai ◽

Toshio Higashi ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Polyarteritis Nodosa ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Inflammatory Infiltration ◽

Content Type ◽

Aneurysm Wall ◽

Visceral Arteries

✓ Polyarteritis nodosa (PAN) is a rare systemic necrotizing arteritis that involves small- and medium-sized arteries in various organs. Although aneurysm formation in visceral arteries is a typical finding in PAN, intracranial aneurysms are much less common, and only a few cases of aneurysm rupture associated with this disease have been documented. In this paper, the authors report on a ruptured PAN aneurysm of the anterior cerebral artery; the lesion was trapped and resected. On histological examination, extensive fibrinoid necrosis and an inflammatory infiltration of leukocytes were seen in the aneurysm wall. To the authors' knowledge this is the first report of subarachnoid hemorrhage from a histologically confirmed PAN aneurysm.

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Hemorrhagic Complications after the Lumbar Injection of Chymopapain

Neurosurgery ◽

10.1227/00006123-198502000-00017 ◽

1985 ◽

Vol 16 (2) ◽

pp. 222-224 ◽

Cited By ~ 2

Author(s):

Aron Buchman ◽

Robert B. Wright ◽

Melvin D. Wichter ◽

Walter W. Whisler ◽

Albert Bosch

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Hemorrhagic Complications ◽

High Doses

Abstract There are few reports of hemorrhagic central nervous system complications after chymopapain injection in humans. Two patients are reported who developed hemorrhagic complications after the lumbar injection of chymopapain. The first developed a hemorrhagic encephalomyelopathy followed by clinically suspected acute arachnoiditis, which responded to high doses of dexamethasone. The second patient developed subarachnoid hemorrhage secondary to vertebral artery aneurysm rupture after the injection of chymopapain.

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The First Description of a Basilar Artery Aneurysm Rupture in 1836

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336383 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Andreas Demetriades ◽

Takashi Horiguchi ◽

James Goodrich ◽

Takeshi Kawase

Keyword(s):

Basilar Artery ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Basilar Artery Aneurysm

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Influence of preoperative corticosteroid treatment on rate of diagnostic surgeries in primary central nervous system lymphoma: a multicenter retrospective study

BMC Cancer ◽

10.1186/s12885-021-08515-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Florian Scheichel ◽

Franz Marhold ◽

Daniel Pinggera ◽

Barbara Kiesel ◽

Tobias Rossmann ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Diagnostic Delay ◽

Central Nervous System Lymphoma ◽

Corticosteroid Treatment ◽

Histopathological Diagnosis ◽

Significant Difference ◽

The Difference ◽

Immunocompetent Patients

Abstract Background Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. Methods A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. Results A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7–6.4). Conclusions Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.

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Re: Morphological risk model assessing anterior communicating artery aneurysm rupture: Development and Validation

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106758 ◽

2021 ◽

pp. 106758

Author(s):

Anahid Hamidianjahromi ◽

Ashkan Mowla

Keyword(s):

Risk Model ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Anterior Communicating Artery Aneurysm ◽

Development And Validation

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Clinical experience with a shape memory polymer peripheral vascular embolisation plug: a case series

CVIR Endovascular ◽

10.1186/s42155-021-00214-w ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Robert A. Morgan ◽

Ian Loftus ◽

Lakshmi Ratnam ◽

Raj Das ◽

Leto Mailli ◽

...

Keyword(s):

Shape Memory ◽

Clinical Experience ◽

Iliac Artery ◽

Shape Memory Polymer ◽

Endovascular Aneurysm Repair ◽

Case Series ◽

Artery Aneurysm ◽

Gelatin Sponge ◽

Peripheral Vasculature ◽

Small Series

Abstract Background Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices. Results Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5–10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45–90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device. Conclusions This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arteries and further experience will demonstrate the utility of the shape memory polymer devices.

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SARS coronavirus 2 and central nervous system manifestations: causation, relation, or coexistence? a case series study and literature review

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1861433 ◽

2020 ◽

pp. 1-6

Author(s):

Seyed Abdolhadi Daneshi ◽

Morteza Taheri ◽

Arash Fattahi

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Literature Review ◽

Case Series ◽

Sars Coronavirus ◽

Case Series Study ◽

Series Study

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An autopsy report of basilar artery aneurysm flow diversion complicated by postoperative day 3 hemorrhage from vessel rupture

BMJ Case Reports ◽

10.1136/bcr-2018-014511 ◽

2018 ◽

Vol 11 (1) ◽

pp. e014511 ◽

Cited By ~ 2

Author(s):

Azeem A Rehman ◽

Ryan C Turner ◽

Stephanie Wright ◽

SoHyun Boo ◽

Ansaar T Rai

Keyword(s):

Subarachnoid Hemorrhage ◽

Basilar Artery ◽

Artery Aneurysm ◽

Symptomatic Improvement ◽

Aneurysm Rupture ◽

Flow Diversion ◽

Atheromatous Plaque ◽

Parent Artery ◽

Autopsy Report ◽

Complete Procedure

A middle-aged patient presented with posterior circulation symptoms attributable to a large eccentric basilar trunk aneurysm. The planned treatment was flow diversion with loose coil packing which was successfully performed using a Pipeline Flex device deployed from the basilar to the left posterior cerebral artery. The complete procedure including live biplane fluoroscopy was digitally recorded. The patient had symptomatic improvement postoperatively and was discharged on day 1. The patient suffered a cardiac arrest on postoperative day 3 secondary to massive intraventricular and subarachnoid hemorrhage. An aneurysm rupture was suspected; however, postmortem examination showed an intact aneurysm sac. The hemorrhage was attributed to a small focal rent in the distal basilar artery next to an atheromatous plaque. The Pipeline device was visible through the rent. This is an autopsy report documenting an injury to the parent artery and not the aneurysm as a source of fatal delayed subarachnoid hemorrhage following flow diversion.

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