Neurological Surgery No Shinkei Geka Volume 19, Issue 7 (July 1991)

Clinicopathological Studies of Three Cases of Cerebral Aneurysms Associated with Systemic Lupus Erythematosus Takakazu KAWAMATA 1 , Mizuo KAGAWA 1 , Osami KUBO 1 , Mikihiko TAKESHITA 1 , Hiroshi UJIIE 1 , Kazuei SATO 1 , Masahiro IZAWA 1 1Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical College Keyword: Systemic lupus erythematosus , Cerebral aneurysm , Subarachnoid hemorrhaze , Vasculitis pp.633-639
Published Date 1991/7/10
  • Abstract
  • Look Inside


We report three cases of ruptured cerebral aneurysms associated with systemic lupus erythematosus (SEE). A 52-year-old woman (case 1) with a fifteen-year history of systemic lupus erythematosus suddenly lost con-sciousness. She was admitted in a state of deep coma. A computed tomography (CT) scan revealed acute hydrocephalus and diffuse suharachnoid hemorrhage inthe basal, interhemispheric and bilateral Sylvian cist-erns. Fifteen years prior to this admission, cerebral angiograms demonstrated no cerebral aneurysm. She underwent ventricular drainage immediately. Postoper-atively, her condition did not improve, and she died on the 18th day. During the autopsy, two saccular cerebral aneurysms were found : one aneurysm was at the right middle cerebral artery bifurcation, and another one was on the anterior communicating artery, which had dis-ruption of the internal elastic lamina and medial smooth muscle, and infiltration of inflammatory cells. In the major cerebral arteries, for example the bilateral inter-nal carotid arteries, disruption or dissection of the inter-nal elastic lamina, intimal fibrosis and transmural infil-tration of inflammatory cells were observed.

The second patient, a 36-year-old woman with a six-year history of SEE, was admitted to our hospital with sudden severe headache. A CT scan showed subarach-noid hemorrhage, and cerebral angiograms diclosed saccular cerebral aneurysms on the anterior communi-cating artery and the left superior cerebellar artery, and a fusiform one on the left posterior cerebral artery. Surgery was not recommended because of her multiple medical problems. Her consciousness improved gradual-ly over 2 months. She was transfered to the department of internal medicine for treatment of renal failure. The third patient, a 34-year-old woman with a seven-year history of SLE, was found to have a ruptured cerebral aneurysm at the basilar artery bifurcation. She underwent clipping. She was transfered to another hos-pital 3 months after the admission.

Review of the literature reveals 24 previous reports of cases of cerebral aneurysms associated with SLE. Most of these aneurysms are attributed to lupus vascu-litis. In SLE, perivascular infiltration of lymphocytes is noted frequently, but true vasculitis of cerebral vessels is relatively rare. As far as the cerebral vessels are con-cerned, destructive changes in the walls are seen com-monly in small cerebral vessels, however, these lesions are uncommon in large vessels. In case 1, internal elas-tic lamina disruption and infiltration of inflammatory cells were found at the aneurysmal necks. In addition to these findings, we observed internal elastic lamina disruption or dissection, transmural infiltration of in-flammatory cells and intimal fibrosis in major cerebral arteries away from the cerebral aneurysms. Based on these histopathological findings and the angiograms taken 15 years previously, we suggest that local weak-ness of cerebral vascular walls and cerebral vasculitis were responsible for the secondary aneurysmal forma-tion.

Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.


Neurological Surgery 脳神経外科
19巻7号 (1991年7月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院