Intracerebral haemorrhage as first manifestation of pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE), a rare inherited, progressive connective tissue disorder, is an uncommon cause of ischemic stroke, mostly due to arterial occlusive small vessel disease. Intracranial haemorrhage rarely occurs in PXE. We report a patient with cerebral bleeding as the first manifestation of PXE, which has not been described before. This atypical presentation led to delayed diagnosis, which was not made until 3 years after the haemorrhage. PXE is a rare but noteworthy cause of ischemic and haemorrhagic stroke and should be considered in young patients lacking vascular risk factors.