Bandeo Lucrecia, Rausch Astrid, Saucedo Miguel, Chertcoff Anibal, Cejas Luciana Leon, Roca Claudia Uribe, Pacha Sol, Pardal Manuel Fernandez, Reisin Ricardo, Bonardo Pablo
Department of Neurology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
Department of Gastroenterology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
J Vasc Interv Neurol. 2018 Nov;10(2):62-64.
The TNF-α antagonists are the drugs used for the treatment of ulcerative colitis (UC). Nontraumatic convexity subarachnoid hemorrhage is an infrequent nonaneurysmal subtype of subarachnoid bleeding caused mainly by reversible cerebral vasoconstriction syndrome (RCVS), cerebral amyloid angiopathy, and posterior reversible encephalopathy syndrome (PRES). We present a 26-year-old female patient with a diagnosis of UC taking Adalimumab. She received her last doses the same day she was admitted to our hospital for an acute severe UC exacerbation. Steroids were added to the treatment. Five days after admission she presented a thunderclap headache with photophobia, nausea, and vomiting. An MRI was performed showing left frontal convexity subarachnoid hemorrhage and hyperintense lesions on T2-weighted and FLAIR sequences located in both occipital lobes, left cerebellar hemisphere, and brainstem. Digital angiography was unremarkable. Adalimumab was discontinued but persisted on treatment with steroids. The patient evolved with complete resolution of her symptoms and was discharged with a normal neurological exam. Two months later, she was asymptomatic and her MRI revealed superficial siderosis secondary to cSAH with resolution of white matter hyperintensities. Convexity subarachnoid hemorrhage in our patient could be secondary to PRES or to RCVS. Analogous MRI findings can be observed in both syndromes, along with similar clinical and angiographic findings. This suggests that both conditions may reflect different manifestations of the same pathology, in which vascular tone and endothelial dysfunction play a major role. To our knowledge, this is the first report of a patient with severe UC and convexity subarachnoid hemorrhage associated with Adalimumab.
肿瘤坏死因子-α拮抗剂是用于治疗溃疡性结肠炎（UC）的药物。非创伤性凸面蛛网膜下腔出血是一种罕见的非动脉瘤性蛛网膜下腔出血亚型，主要由可逆性脑血管收缩综合征（RCVS）、脑淀粉样血管病和后部可逆性脑病综合征（PRES）引起。我们报告一名26岁女性患者，诊断为UC，正在服用阿达木单抗。她在因急性重度UC加重入院的同一天接受了最后一剂药物。治疗中加用了类固醇。入院五天后，她出现霹雳样头痛，伴有畏光、恶心和呕吐。进行了MRI检查，显示左额叶凸面蛛网膜下腔出血，以及位于枕叶、左小脑半球和脑干的T2加权和液体衰减反转恢复序列上的高信号病变。数字血管造影未见异常。停用了阿达木单抗，但继续使用类固醇治疗。患者症状完全缓解，出院时神经系统检查正常。两个月后，她无症状，MRI显示cSAH继发的浅表性铁沉积症，白质高信号消失。我们患者的凸面蛛网膜下腔出血可能继发于PRES或RCVS。在这两种综合征中均可观察到类似的MRI表现，以及相似的临床和血管造影表现。这表明这两种情况可能反映了同一病理的不同表现，其中血管张力和内皮功能障碍起主要作用。据我们所知，这是第一例严重UC患者并发与阿达木单抗相关的凸面蛛网膜下腔出血的报告。
