Massive Intracerebral Hemorrhage as a First Manifestation of Large Vessel Vasculitis: Case Report

We report a case of a 46-year-old woman who presented to our emergency department with sudden onset of impaired consciousness, right flaccid hemiparesis, and aphasia. Plain computed tomography (CT) of the brain showed large intracerebral hemorrhage (ICH) in the left basal ganglia with extension into the ventricle. The patient was admitted to intensive care unit (ICU), and neurosurgical assessment was done with the decision to apply conservative treatment with close monitoring of neurological status and vital parameters. During the course of treatment, thorough diagnostic work was performed revealing that our patient was most likely affected with large vessel vasculitis (LVV), presumably Takayasu arteritis (TA). Immunosuppressive treatment was initiated with slight neurological improvement in the course of few weeks; currently, the patient is going through physical rehabilitation and is being followed up. Although neurological symptoms occur in substantial proportion of the patient affected with LVV, literature reporting massive intracerebral hemorrhage as well as occurrence of neurological symptoms as the first manifestation of the disease is scarce.