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January 1979

Intracranial Hemorrhage With Vasculitis in Rheumatoid Arthritis

Author Affiliations

Dept of Neurol Toronto Western Hospital Toronto, Ontario, Canada M5T 2S8

Arch Neurol. 1979;36(1):58. doi:10.1001/archneur.1979.00500370088026

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 arthritis1-7 shows that in only one of these did hemorrhage occur.5 In this instance (case