Abstract
We report a case of subarachnoid hemorrhage associated with systemic lupus erythematosus. The 53-year-old female patient had suffered from Raynaud Syndrome butterfly rash, skin erosion, stomatitis, arthritis, pyrexia, pneumonia, pericarditis and lupus nephritis for 10 years. Antinuclear, DNA, SS-A, CL-β2GP1 and SCL-70 antibodies were positive. Subarachnoid hemorrhage happened just after pulse treatment with steroid hormone and angiography showed dissecting aneurysm of the right vertebral artery.
Neck clipping was performed for the saccular portion of this fusiform aneurysm. However, rebleeding occurred two days after operation and trapping of the right vertebral artery was done. The arterial dissection was found to deteriorate and fusiform-like dilatation with intramural hemorrhage was seen on the operation. After operation, the patient suffered from athelectasis, pneumonia, nephrosis, pleural effusion and pulmonary edema due to the hypoalbuminemia and overhydration. The consciousness level recovered well in the chronic stage but she now has a tracheostomy, requires tube feeding and is confined to a wheel chair.
Systemic lupus erythematosus is often associated with the fusiform aneurysm of the major cerebral artery as shown in this case. The trapping operation is recommended for this fusiform aneurysm. Furthermore, intensive care is necessary to prevent infection, renal and cardiac failure and bleeding tendency.
