title: Subarachnoid hemorrhage and systemic lupus erythematosus.
abstract: The frequency, clinical profile, treatment and outcome of subarachnoid hemorrhage (SAH) in patients with systemic lupus erythematosus (SLE) were assessed retrospectively, based on the case records of SLE of the Jichi Medical School Hospital over a 20 year period. Clinically defined SAH was found in 10 (3.9%) out of 258 SLE patients, which represented a frequency higher than previously assumed. Five patients had active SLE and lacked an apparent cause of SAH, other than SLE. A high mortality rate (5/5), no visible aneurysm on angiogram (3/4), and an onset during intractable SLE or after discontinued or no steroid therapy because of medical noncompliance (4/5) were characteristic of patients with active SLE, and thus an earlier successful suppression of SLE, if possible, might have prevented their SAH. In contrast, in the 5 patients with inactive SLE, 2 out of 3 saccular aneurysms were successfully clipped and small bleeding of one patient without aneurysms remitted spontaneously without the need for additional steroid therapy. When one death, which occurred outside of medical care, was excluded, the survival ratio of the hospitalized SAH patients with inactive SLE was significantly better than that with active SLE (3/4 versus 0/5, P=0.0476). In conclusion, the relatively common occurrence of SAH in SLE patients, and a significantly different clinical impact of SAH in respect to active and inactive SLE, were suggested from the results.
authors.affiliation: Division of Rheumatology and Clinical Immunology, Jichi Medical School, Minamikawachi-machi, Kawachi-gun, Tochigi, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Mimori
authors.forename: T
authors.initials: T
authors.lastname: Suzuki
authors.forename: M
authors.initials: M
authors.lastname: Hashimoto
authors.forename: H
authors.initials: H
authors.lastname: Nara
authors.forename: T
authors.initials: T
authors.lastname: Yoshio
authors.forename: J I
authors.initials: JI
authors.lastname: Masuyama
authors.forename: H
authors.initials: H
authors.lastname: Okazaki
authors.forename: D
authors.initials: D
authors.lastname: Hirata
authors.forename: S
authors.initials: S
authors.lastname: Kano
authors.forename: S
authors.initials: S
authors.lastname: Minota
mesh_terms: D000328:Adult; D017668:Age of Onset; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery; D007564:Japan / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality