• Katsuhiro Tanaka, Masaya Fujiwara, Yasuyuki Okuda, Fujimaro Ishida, and Hidenori Suzuki.
• Department of Neurosurgery, NHO Mie Chuo Medical Center, Mie, Japan. Electronic address: tk_0303_ns@yahoo.co.jp.
• World Neurosurg. 2020 Feb 1; 134: 79-85.

BackgroundSegmental arterial mediolysis (SAM) is a rare non-atherosclerotic, noninflammatory vascular disease, characterized by mediolysis. We report an extremely rare case of subarachnoid hemorrhage (SAH) due to a ruptured blood blister-like aneurysm (BBA) of the internal carotid artery associated with SAM-related arteriopathy.Case DescriptionWe experienced a case of SAH followed by intraperitoneal hemorrhage that occurred 12 days after the SAH onset. SAH was caused by a ruptured BBA of the internal carotid artery, which was treated by trapping with high-flow bypass. Intraperitoneal hemorrhage was caused by a rupture of a posterior inferior pancreaticoduodenal artery (PIPDA) aneurysm, which induced hypovolemic shock resulting in death in spite of endovascular internal trapping. Postmortem pathologic examination revealed that the PIPDA pseudoaneurysm was due to SAM.ConclusionsWe should pay attention to the association of SAM, which is a potentially life-threatening pathology when treating cerebral BBAs.Copyright © 2019 Elsevier Inc. All rights reserved.

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