Diagnosis and monitoring of cerebral hyperfusion after carotid endarterectomy with single photon emission computed tomography: case report

OBJECTIVE AND IMPORTANCE: Aortitis syndrome is a systemic vasculitis of unknown etiology, affecting mainly the major branches of the aorta and leading to stenosis or occlusion. Intracranial aneurysms are rarely associated with this syndrome. Only 15 cases have been previously reported. CLINICAL PRESENTATION: A 54-year-old woman with a 10-year history of aortitis syndrome demonstrated nonruptured cerebral aneurysms in the left internal carotid and anterior communicating arteries, with decreased flow in the right internal carotid artery and ipsilateral A1 segment. INTERVENTION: The patient underwent clipping of the aneurysms through a left pterional craniotomy and transsylvian approach. CONCLUSION: In our review of 16 reported cases, including the present case (13 with ruptured aneurysms and 3 with nonruptured aneurysms), there were 25 saccular aneurysms, and we noted the following clinical characteristics: 1) patient age was 26 to 64 years, with an average of 50.2 years; 2) aneurysms arose predominantly along the course of collateral flow, especially in the vertebrobasilar system (13 of 25 aneurysms, 52.0%); 3) there was a high incidence of multiplicity (7 of 16 cases, 43.8%). These characteristics suggest that increased hemodynamic stress, produced by stenosis or occlusion of the major branches of the aorta and systemic hypertension, plays an important role in the development of cerebral aneurysms in patients with this syndrome.