Subarachnoid and Intracerebral Hemorrhage in Patients with Churg-Strauss Syndrome: Two Case Reports

Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia, and asthma. The exact etiology of CSS is unknown. This syndrome commonly affects the lungs, peripheral nerves, skin, heart, and gastrointestinal tract, but rarely the central nervous system. Subarachnoid and intracerebral hemorrhage in CSS patients is extremely rare; however, clinicians should consider that CSS may be a cause of intracranial hemorrhage and its high rate of mortality and morbidity. The authors report on two cases of subarachnoid and intracerebral hemorrhage with CSS and discuss a brief review of CSS.

The Clinical Characteristics and Treatment Outcomes of Patients with Ruptured Middle Cerebral Artery Aneurysms Associated with Intracerebral Hematoma

OBJECTIVE: The objective of this study is to evaluate the clinical presentation and outcomes of patients with an intracerebral hematoma (ICH) associated with a ruptured middle cerebral artery (MCA) aneurysm, and the correlation factors associated with the aneurysm and characteristics of the hematoma. METHODS: A retrospective evaluation of clinical and radiologic characteristics and outcomes was conducted for 24 patients (11 men and 13 women; mean age, 53 years) with ruptured MCA aneurysms associated with ICH between September 2008 and December 2011. RESULTS: Thirteen (54%) of the 24 patients had a favorable outcome, four (17%) suffered from severe disability, and seven (29%) died. Based on Hunt and Hess grade, one patient was classified as Grade II, three as Grade III, 12 as Grade IV, and eight as Grade V. Patients with an unfavorable outcome had significantly larger aneurysms (p = 0.047) and ICH volumes (p = 0.002), compared with patients in the group with a favorable outcome. The most frequent rupture point of aneurysms was the lateral aspect of the aneurysm (54.2%). When the rupture point is toward the lateral direction, the distribution of ICH tended to be located at the temporal lobe and intrasylvian. CONCLUSION: Results of the present study suggest an association of the initial clinical state, the size of the aneurysm, and ICH volume with outcome. Although no difference was observed between the location of the rupture point and patient outcomes, an accurate assessment of ICH patterns and the rupture point in angiography may help to ensure surgical exposure and a safe aneurysm clipping.