Multiple Dissecting Intracranial and Extracranial Aneurysms in Rheumatoid Arthritis: A Rare Case

Abstract

A 52 year old female with a history of rheumatoid arthritis (RA) and persistently raised levels of serum rheumatoid factor and cyclic citrunillated peptide, presented with dissecting aneurysms at the right internal carotid artery, and intact aneurysms at the supraclinoid segment and opening of the right opthalmic artery. Coil embolization was performed. The patient developed an ischaemic stroke two days later. Intra and extra-cranial large vessel aneurysms in RA have rarely been reported in the literature. RA patients with persistent systemic inflammation are at increased risk of developing vascular complications and ischaemic stroke. Here, high levels of tissue-deposited immune complexes may have resulted in cerebral artery vasculopathy. Risk stratification for the development of vascular complications, including cranial aneurysms and ischaemic stroke, in RA patients with poorly controlled systemic inflammation, is important; especially when we consider the neurological sequelae associated with dissecting cerebral aneurysms, cerebral infarction and surgical intervention.