Abstract
A case of thromboangiitis obliterans associated with multiple cerebral aneurysms is presented.
A 69-year-old woman in coma was ambulated on April 4, 1989. She complained of severe headache and numbness of her right cheek the night before admission. She had been suffering from thromboangiitis obliterans since she was 38 years old, which was angiographically diagnosed at her age of 58. Computed tomogram of the head revealed a subarachnoid hemorrhage with intracerebral hematoma in the left temporal lobe. Left carotid angiogram revealed two saccular aneurysms, located in the middle cerebral artery and the distal anterior cerebral artery and the severe stenosis of the middle cerebral artery and the mild stenosis of C3 portion. On right carotid angiogram, the carotid stenosis at C3 portion was observed. Smooth tapering of the arteries in the cerebellar hemispheric region, implying the cerebral thromboangiitis obliterans was found on the vertebral angiogram.
Emergent operation was performed to clip the middle cerebral artrial aneurysm and to evacuate the hematoma. Her postoperative recovery was remarkable and she tolerated well the second operation for the aneurysm of the distal anterior cerebral artery 3 weeks later. She discharged on her feet with a minimal comprehensive aphasia.
The association of thromboangiitis obliterans and cerebral aneurysm is rare. The underlying mechanism of this rare association was considered the mere coincidence but might be postulated to be derived from the common cause of the collagen abnormality.
