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Rehabilitation Practice and Science

Translated Title

韋格納肉芽腫病人併雙側同時顱內出血：個案報告及文獻回顧

Abstract

Background: Simultaneous multiple intracerebral hemorrhages (ICHs) are rare and their underlying mechanisms are unknown. Reported etiologies include hypertension, vasculitis, cerebral amyloid angiopathy, venous sinus thrombosis, coagulopathy, and intracranial vascular anomalies. Granulomatosis with polyangiitis (GPA; Wegener's granulomatosis) is a necrotizing granulomatous vasculitis affecting small- and medium-sized vessels of the respiratory tract and kidneys. The reported frequency of central nervous system (CNS) involvement in GPA is 0%-16.4%. Case presentation: A 34-year-old man with hypertension presented with a sudden loss of consciousness and weakness in the right limbs. Brain computed tomography (CT) showed a left basal ganglion hemorrhage and right basal ganglion infarction with hemorrhagic transformation. Brain CT angiography revealed stenosis of the M1 segment of the right middle cerebral artery (MCA) and irregularity of the left MCA branches. GPA was suspected due to persistent sinusitis, microscopic hematuria, detection of cytoplasmic antineutrophil cytoplasmic antibodies, and multiple cerebral vessel irregularities. We assume that the underlying vessel abnormalities resulted from GPA. Uncontrolled hypertension induced the left basal ganglion hemorrhage and right basal ganglion infarction with hemorrhagic transformation. It is known that right M1 territory collateral circulation had been established before this cerebrovascular accident because cerebral angiography revealed complete occlusion of the right M1 segment with profound collateral circulation. Therefore, our patient had intact left side muscle strength despite right basal ganglion infarction with hemorrhagic transformation. Conclusion: Spontaneous ICH is a rare but fatal complication of GPA. The mechanism underlying simultaneous multiple ICH remains unknown. Considering CNS manifestations can be the first presenting feature of GPA, GPA should be considered in the differential diagnosis of patients with simultaneous multiple ICHs.

Language

English

First Page

263

Last Page

271

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