Complications Associated with Management of Aneurysmal Subarachnoid Hemorrhage in Patients with Fibromuscular Dysplasia: Case Report and Literature Review

Abstract

Individuals with fibromuscular dysplasia (FMD) have a higher risk of developing cerebral aneurysms. When this subgroup of patients presents with aneurysmal subarachnoid hemorrhage, management of cerebral vasospasm can be particularly challenging, both because they may be more susceptible to developing refractory vasospasm and also because they are at a higher risk for extracranial vascular injury from treatment. A female with Hunt-Hess Grade-1, Fisher Grade-2 subarachnoid hemorrhage from a ruptured left supraclinoid internal carotid artery (ICA) aneurysm was incidentally diagnosed with FMD during angiography for endovascular treatment of the aneurysm. She developed severe cerebral vasospasm refractory to aggressive medical and endovascular therapy. Early during the course of her treatment, she developed a symptomatic ICA dissection with multiple small dissecting aneurysms from hypertensive therapy, requiring stent placement. During our management of this patient, a literature review demonstrated limited information regarding management strategies for these patients. Therefore, with this article we intend to convey our experience with potential complications from subarachnoid hemorrhage management in this subgroup of patients and to review the available literature regarding this topic.