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[Recurrent multiple cerebral hemorrhages complicated with polyarteritis nodosa]
Masaru Shimizu1, Mari Honma, Kazuhiro Endo
1Department of Neurology, Fukusima Medical University.
Rinsho Shinkeigaku = Clinical Neurology
|March 29, 2003
Summary
This study reports a rare case of recurrent cerebral hemorrhages in a patient with polyarteritis nodosa. The cause was linked to cerebrovascular amyloidosis and inflammation of venous sinuses, not typical vasculitis.
Area of Science:
- Neurology
- Pathology
- Vascular Medicine
Background:
- A 72-year-old woman with a history of polyarteritis nodosa and vasculitic neuropathy presented with neurological deficits.
- Initial presentation included somnolence, right leg monoparesis, and disorientation.
Observation:
- Neuroimaging revealed multiple superficial cerebral hemorrhages and dural enhancement.
- Cerebral vasculitis was not evident in arterial or venous structures via MRV and helical CTs.
- The patient experienced three recurrent intracerebral hemorrhages during hospitalization.
Findings:
- Brain biopsy after the third hemorrhage showed cerebrovascular amyloidosis without inflammation.
- Pachymeningitis (inflammation of the dura mater) was present.
- Inflammation likely affected cortical and bridging veins draining into venous sinuses, suggesting impaired venous drainage.
Implications:
- Pachymeningitis-induced impaired venous drainage may be a mechanism for recurrent cerebral hemorrhages in amyloid angiopathy.
- This case highlights a potential link between venous sinus inflammation, amyloid angiopathy, and recurrent bleeding.
- Challenges traditional understanding of vasculitis in recurrent intracranial hemorrhage.