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May 2013

A Questionable Cause of Intracerebral Hemorrhage—Reply

Author Affiliations

Author Affiliation: Department of Neurology, Duke University Medical Center, Durham, North Carolina.

JAMA Neurol. 2013;70(5):653-654. doi:10.1001/jamaneurol.2013.21

In reply

Sethi has raised some important points that merit attention and clarification. He points out that migraine-induced intracerebral hemorrhage (ICH) is indeed very rare, therefore, every case reported in the literature is a diagnosis of careful exclusion. We second this opinion; therefore, our case was worthy of report.1

Furthermore, he raised the possibility of an underlying arteriovenous malformation (AVM) in our case. First, he points out that the headaches were consistently lateralized to the left parietooccipital, questions the diagnosis of migraine, and suggests an underlying AVM as the possible diagnosis. He further suggests considering a repeat angiogram in a few weeks to rule out this possibility.

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