Subarachnoid hemorrhage as a form of onset of systemic lupus erythematosus
Introduction. The most frequent cause of spontaneous subarachnoid hemorrhage (SAH) is rupture of intracranial arterial aneurysms (>70%). The remainder are due to many different aetiologies. Although SAH is a relatively common neuropathological finding in systemic lupus erythematosus (SLE), it is normally due to the extent of the intercerebral hemorrhage and not to its isolated presentation. Clinical case. We report the case of a 34 year old woman who presented with non-traumatic SAH at the onset of her lupus disorder. The patient was attended for SAH and at the same time a multisystemic disorder and severe thrombocytopenia were found, leading to a diagnosis of SLE. The neuroimaging techniques, selective cerebral arteriography, cerebral and spinal magnetic resonance, and magnetic resonance angiography did not show any vascular malformations. The patient was treated with immunosuppressive therapy, nimodipine, and following angiographic tests, with antiaggregants and anticoagulants. Conclusions. The greater frequency of SAH in patients with lupus, as compared to the general population, has been attributed to the presence of intracranial vasculitis. However, neuropathological studies have shown that true vasculitis is very infrequent in the central nervous system of SLE patients. In the case we describe, the first in which SAH appeared at the onset of the disease, we consider that the origin of the hemorrhage was her high arterial blood pressure and thrombopenia
Caso clínico Comunicamos el caso de una mujer de 34 años que presentó HSA no traumática en el debut de su enfermedad lúpica. La paciente fue atendida por HSA y coincidentemente se descubrió afectación multisistémica y trombopenia grave que permitieron el diagnóstico de LES. Las pruebas de neuroimagen realizadas, arteriografía cerebral selectiva, resonancia magnética cerebral y medular y angiografía por resonancia magnética no descubrieron malformaciones vasculares. La paciente fue tratada con terapia inmunosupresora, nimodipino y, tras las pruebas angiográficas, con antiagregantes y anticoagulantes.
Conclusiones La mayor frecuencia de HSA en la población lúpica con respecto a la población general se ha atribuido a la existencia de vasculitis intracraneal. Sin embargo, los estudios neuropatológicos realizados han revelado que la verdadera vasculitis es muy infrecuente en el sistema nervioso central de los enfermos con LES. En el caso que describimos, el primero en el que la HSA aparece en el debut de la enfermedad, creemos que debe buscarse el origen de la hemorragia en las altas cifras de tensión arterial y la trombopenia presentada por la paciente
