[Recurrent multiple cerebral hemorrhages complicated with polyarteritis nodosa].
In January 2001, a 72-year-old woman, who had been treated for polyarteritis nodosa, and vasculitic neuropathy, was admitted in somnolent state. She was monoparetic in her right leg, and disoriented. Neuroimaging studies revealed multiple superficial parenchymal hemorrhages in the bilateral hemispheres with dural Gd enhancement and parenchymal thickenings. No evidence of intracranial vasculitis was seen in visible arterial branches and veins by MRV and helical CTs. While in the hospital, intracerebral hemorrhage recurred three times. In April 2001, the third large intracerebral hemorrhage occurred, for which the removal of hematoma was carried out and brain biopsy was done. The specimens showed an evidence of cerebrovascular amyloidosis, but no inflammation. In view of the absence of angitis in the parenchymal and pial blood vessels, despite the presence of pachymeningitis, the cortical and bridging veins which drained into the venous sinuses, were likely involved in inflammation. Impaired venous drainage due to pachymeningitis might be a mechanism by which recurrent multiple cerebral hemorrhages have taken place in the presence of amyloid angiopathy.
Shimizu
Masaru
M
Department of Neurology, Fukusima Medical University.
Honma
Mari
M
Endo
Kazuhiro
K
Hoshi
Akihiko
A
Matsuura
Yutaka
Y
Watanabe
Akiko
A
Saito
Naoshi
N
Yamamoto
Teiji
T
D000368:Aged; D016657:Cerebral Amyloid Angiopathy / Q000150:complications; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D010488:Polyarteritis Nodosa / Q000150:complications*; D012008:Recurrence; D014057:Tomography, X-Ray Computed