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[A case of fibromuscular dysplasia associated with intra- and extracranial multiple aneurysms].

A case of fibromuscular dysplasia (FMD) with intra- and extracranial multiple aneurysms is reported. A 42-year-old woman was admitted to Kagawa Central Hospital with severe headache and stiffness of the neck. CT scan showed subarachnoid hemorrhage predominantly in the left side of the basal cisterns and hydrocephalus. Angiography at admission revealed marked stenosis and dilatation of the extracranial major arteries and multiple aneurysms in the lt. PCA, lt. ICA, bil. VA, and the lt. renal artery. String-of-beads appearance was also seen in the branches of the lt. external carotid artery. During the operation, the PCA aneurysm which has been diagnosed as the ruptured one, was found to arise from the posterior communicating artery itself. It was thus a so-called true posterior communicating aneurysm. The aneurysm was trapped by clipping the artery on both the ICA and the PCA sides. The giant aneurysm of the lt. ICA was successfully treated by lt. STA-MCA anastomosis and ligation of the lt. ICA. Postoperative angiography demonstrated no visualization of the aneurysm and total occlusion at the origin of the lt. VA that had been patent preoperatively. On histological examination, intimal and medial hyperplasia was seen in the aneurysmal wall and occipital artery biopsied at operation. There has been no report of FMD associated with multiple and very rare posterior communicating aneurysms. Wide involvement of vascular change and advance of arterial occlusion noted by serial angiography indicates that FMD is a disease in which pathology would be progressive in some cases.