An Intraabdominal Hemorrhage Affected by Catecholamine Surges Caused by Subarachnoid Hemorrhage:A Case Report

Abstract

Intraabdominal hemorrhage is a rare complication of subarachnoid hemorrhage(SAH). Recently, there have been a number of reports about the coexistence of intracranial and Intraabdominal aneurysms caused by segmental arterial mediolysis(SAM). The etiology of SAM is still unclear, but catecholamine is known to be one of the causes of SAM. The authors report a rare case in which an increase of catecholamine by SAH affected the Intraabdominal hemorrhage during the perioperative period of SAH. A 67-year-old woman was admitted to our hospital with SAH. Cerebral angiography revealed a right internal carotid-posterior communicating artery aneurysm, and an emergent neck clipping was performed. The intraoperative finding was a saccular aneurysm with a partial red wall of the internal carotid artery. Thirteen days after SAH, the patient complained of abdominal pain, but there were no particular findings on abdominal CT. The next day, anemia progressed suddenly because of Intraabdominal hemorrhage caused by rupture of the splenic artery aneurysm. She developed shock and consciousness disturbance, and left hemiparesis due to vasospasm appeared. She recovered from shock after receiving transfusion and coil embolization of the splenic artery aneurysm. Her consciousness and left hemiparesis improved after two months of rehabilitation. The radiological findings of the splenic artery aneurysm are compatible with SAM. We believe that an increase in catecholamine by SAH affected the development and rupture of the splenic artery aneurysm. In cases of SAH with abdominal pain, a detailed examination of the abdomen might be needed, and the use of catecholamine for symptomatic vasospasm should be carefully performed.