Intracranial Hemorrhage With Vasculitis in Rheumatoid Arthritis

Abstract

To the Editor.— Edwards has described two patients with intracranial hemorrhage occurring with cerebral arteritis ( Arch Neurol 34:549-555, 1977). One of these cases was a subarachnoid hemorrhage secondary to amphetamine-induced necrotizing angitis. The second was an intracerebral hematoma in association with intracranial arteritis and anticoagulant therapy in a patient with ulcerative colitis. They pointed out that intracranial hemorrhage with cerebral vasculitis is not well recognized. We published a case in the context of CNS vasculitis in rheumatoid disease, 1 itself a rare entity in the literature. The hemorrhagic aspect of the vasculitis was not considered a remarkable feature in that report. In our case, four separate areas of the brain were involved by hemorrhage at at least two different times. The symmetry is remarkable. A review of the eight cases of CNS vasculitis in rheumatoid arthritis 1-7 shows that in only one of these did hemorrhage occur. 5 In this instance (case