Childhood subarachnoid hemorrhage associated with fibromuscular dysplasia

A rare case of childhood subarachnoid hemorrhage (SAH) is reported. A 5-yea r-old boy presented with SAH. A cerebral angiogram showed obstruction of th e first segment of the left anterior cerebral artery (Al). The Al was surgi cally trapped to prevent rebleeding. Proliferation of myofibroblasts was re vealed in the intima of the Al. Cerebral infarction appeared in the territo ry of the left middle cerebral artery (MCA) on day 2 after onset of SAH, an d the patient suffered a second SAH on day 26. The second angiogram showed stenosis and a saccular aneurysm in the left MCA. A second surgery, neck cl ipping of the aneurysm, was needed. The multiple arterial lesions and histo logical findings indicated that the SAHs and the infarction were caused by the dissecting aneurysm affected with fibromuscular dysplasia (FMD). Intrac ranial FMD is mainly detected in children and causes cerebral ischemia and bleeding. Surgical treatment of childhood SAH should be discretely chosen w ith due consideration for FMD.