Giant cell arteritis in a 19-year-old woman associated with vertebral artery aneurysm and subarachnoid hemorrhage

Giant cell arteritis (GCA) is a disease chiefly found in elderly patients. Intracranial vessels are rarely involved in GCA. Here we report the case of a 19-year-old woman with GCA in the basilar and vertebral arteries. Two we eks after the first symptoms, she developed an aneurysmatical dilatation of the right vertebral artery which ruptured leading to subarachnoid hemorrha ge. Although the ruptured right vertebral artery was clipped neurosurgicall y, she died two days later. Autopsy revealed GCA with focal medial necrosis and intimal thickening of the vertebral arteries and the basilar artery. N o other arteries were affected. In the involved vessels, the media exhibite d Clq immunoreactivity. At the intimal site of the internal elastic lamina there were increased levels of elastase. Other arterial diseases showing th e pattern of GCA were excluded. This case demonstrates that GCA is not nece ssarily restricted to elderly people. Moreover, this case shows that a GCA- induced aneurysm is a very rare reason for subarachnoid hemorrhage even in young adults.