SLE related ruptured aneurysm could occur with causes other than angiitis： A case report of clinicopathological study

Abstract

A 43‒year‒old woman suffering from SLE was transported to our hospital because of the deterioration of her consciousness initiated with a sudden onset headache. Emergency surgery was performed for an acute subdural hematoma and a saccular cortical aneurysm of the right posterior cerebral artery was detected as an origin of the hemorrhage. Postoperative examination showed another cortical aneurysm and severe stenosis of the terminal portion of the right carotid artery which was diagnosed with the quasi‒ moyamoya disease. Another aneurysm ruptured during her hospital stay and we surgically removed it. Pathological examination demonstrated perivascular infiltration and vascular dilatation and there was no feature of the typical angiitis. Pathological reports about cerebral aneurysms in patients with SLE are extremely rare and almost all of them reveal that the cause of these aneurysms is an angiitis related to SLE. We considered that development and dilatation of collateral arteries due to quasi‒moyamoya disease, and the SLE related perivascular infiltration are possible causes of the development and rupture of the aneurysms.