Subarachnoid hemorrhage in systemic lupus erythematosus in Japan: two case reports and a review of the literature

Abstract

We report 51- and 43-year-old Japanese female patients with systemic lupus erythematosus (SLE) associated with subarachnoid hemorrhage (SAH) due to rupture of intracranial saccular aneurysms. We also review the literature of Japanese SLE patients with SAH. SAH in Japanese SLE patients is more frequent than in patients from Western countries, has different features from the general population, and can occur regardless of SLE disease activity. Clinicians must pay attention to SAH in all SLE patients.

Subarachnoid hemorrhage in systemic lupus erythematosus: Systematic review and report of three cases

“…Uncommon lesions like distal fusiform aneurysms [7,9,[13][14][15][16] or clinical entities like angio-negative SAH with an unusual torpid clinical course [10,17] are frequently described when SAH occurs in SLE. Multiple aneurysms outside the typical branching sites, are also frequently reported as the pathological finding in SLE patients with SAH [9,13,[18][19][20]. Here we aim to summarize all this literature by describing what we found to be the three most typical clinical scenarios reported in patients with SAH and SLE.…”

“…From our knowledge, only Owada et al reviewed an incidence of single and multiple aneurysms of 69.5% and 31.6%, respectively, among Japanese SLE reports [10,20,25]. Saccular or berry aneurysms would be explained by an increased incidence of hypertension; fusiform distal aneurysms could be somehow related to focal vasculitis; but the higher incidence of multiple aneurysms in SLE patients lacks a plausible explanation.…”

Fulminant Vasculitis Associated with Extracranial Dissections and Occlusion, Ischemic Strokes, and Aneurysm Rupture: Case Report and Review of the Literature

“…3,7 These patients have a worse prognosis, higher mortality, and a greater Hunt and Hess grade. 3,5,[7][8][9][10][11][12][16][17][18][19] One reported patient with SLE and aneurysmrelated subarachnoid hemorrhage presented with rapidly progressive increase in size of the intracranial aneurysm with subsequent rerupture. 3 Rarely, tuberculosis and CNS aspergillosis have been implicated in vasculitis leading to aneurysm formation with subsequent rupture (Table 1).…”

Ruptured aneurysm at the fenestration of the middle cerebral artery detected by magnetic resonance angiography in a patient with systemic lupus erythematosus and renal failure: a case report

“…Although SAH due to ruptured aneurysm has rarely been reported in patients with SLE, SAH in Japanese patients with SLE is more frequent than in patients from Western countries and can occur regardless of SLE disease activity [7]. The mortality rate associated with SAH is relatively high (38.6%) in Japanese patients with SLE [7]. …”