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Unraveling the Puzzle: A Case Report Questioning the Causal Relationship Between Subarachnoid Hemorrhage and

Ashbina Pokharel1, Indira Acharya2, Joseph Skender3

  • 1Internal Medicine, Beaumont Hospital, Royal Oak, USA.

Cureus
|June 30, 2023
PubMed

Insights

A rare case of subarachnoid hemorrhage (SAH) occurred in a patient with microscopic polyangiitis (MPA), a type of ANCA-associated vasculitis. Prompt medical and immunosuppressive treatment led to patient improvement.

Area of Science:

  • Nephrology
  • Neurology
  • Rheumatology

Background:

  • Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are systemic autoimmune diseases affecting small-to-medium-sized blood vessels.
  • Microscopic polyangiitis (MPA), a subtype of AAV, primarily impacts the kidneys and lungs.
  • Subarachnoid hemorrhage (SAH) is a rare but severe neurological complication associated with AAV.

Observation:

  • A 67-year-old female with newly diagnosed ANCA-associated renal vasculitis presented with sudden severe headache.
  • Cerebral imaging revealed both subarachnoid hemorrhage (SAH) and intraparenchymal hemorrhage.
  • Kidney biopsy confirmed pauci-immune glomerulonephritis with positive ANCA and myeloperoxidase antibodies.

Findings:

  • The patient received medical management for the intracranial hemorrhages.
  • Immunosuppressive therapy, including steroids and rituximab, was administered for the ANCA vasculitis.
  • The patient demonstrated clinical improvement following treatment for both conditions.

Implications:

  • This case highlights the rare but critical association between ANCA vasculitis and intracranial hemorrhage.
  • Early diagnosis and multidisciplinary management are crucial for improving outcomes in patients with AAV and neurological complications.
  • Further research may elucidate the specific mechanisms linking AAV to cerebrovascular events.
Keywords:
anca-associated vasculitiscerebral vasculitismicroscopic polyangiitissubarachnoid hemorrhagevasculitis

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