Intracerebral Hemorrhage in a Patient with Untreated Rheumatoid Arthritis: Case Report and Literature Review

Abstract

Rheumatoid vasculitis (RV) occurs in patients with long-standing rheumatoid arthritis (RA) or high levels of immunological factors and can result in devastating cardiovascular (CV) events. Here we report a case of a 38-year-old male who presented with hypertensive emergency and intracerebral hemorrhage (ICH). In the literature, a few observational studies have indicated the association of RA with hypertension; however, little evidence exists supporting a direct relationship between RA and ICH. In this case, we attempted to evaluate the complex relationship between all of these factors and found that early detection and treatment of RA may be beneficial in reducing ICH; however, large studies in the future are warranted to validate our observation.

A Neurological Complication in Rheumatoid Arthritis – A Scenario of Catastrophic Proportions

“…It is important to note that a normal CT angiography of cerebral vessels cannot rule out vasculitis and diagnosis had to rely on histopathological changes. CNS involvement has been very rarely reported in patients with RV[ 15 ] and intracerebral haemorrhage has only been reported with the presence of hypertension. [ 16 ] The clinical presentation is varied in cerebral RV ranging from vascular headaches, seizures, cranial neuropathies or cerebrovascular events.…”

Intracerebral hemorrhage due to moyamoya syndrome as a rare presentation of cerebral rheumatoid vasculitis: a case report

“…However, central nervous system vasculitis in RA is sort of rare and the literature contains solely few case reports on intracranial arteritis presenting as intracerebral hemorrhage (ICH). [3].…”