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Intracranial Segmental Arterial Mediolysis: Report of 2 Cases and Review of the Literature

Alturkustani, Murad FRCPC*†; Ang, Lee-Cyn FRCPC*

American Journal of Forensic Medicine & Pathology:
doi: 10.1097/PAF.0b013e31828879e8
Case Reports

Abstract: Extensive nontraumatic subarachnoid hemorrhage is an important cause of unexpected death in young adults. Segmental arterial mediolysis (SAM) represents an uncommon pathologic finding in the intracranial blood vessels associated with this type of hemorrhage. Segmental arterial mediolysis is a pathologic entity with putative vasospastic etiology, which recently has been reported to be associated with Ehlers-Danlos syndrome type 4. We describe 2 additional cases of ruptured intracranial vertebral artery with features of SAM that resulted in fatal subarachnoid hemorrhage. We also review the literature on vessels with features of SAM that are either intracranial or affecting the internal carotid artery with major direct effects (ie, stroke or transient ischemic attack) on the central nervous system.

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From the *Department of Pathology (Neuropathology), University Hospital, University of Western Ontario, London, Ontario, Canada; and †Department of Pathology, King Abdulaziz University and Hospital, Jeddah, Kingdom of Saudi Arabia.

Manuscript received January 12, 2012; accepted June 22, 2012.

The submitted article has not been submitted for publication before.

The authors report no conflicts of interest.

Reprints: Murad Alturkustani, FRCPC, University of Western Ontario, 339 Windermere Rd, London, ON, Canada N6A 5A5. E-mail:

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© 2013 by Lippincott Williams & Wilkins.