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Wegener’s Granulomatosis Presenting with Intracerebral Hemorrhages

Introduction Wegener’s granulomatosis is a disease of unknown causes, usually affecting adults and predominating in males with a ratio of 2:1. The main features are subacutely evolving necrotizing granulomata of the upper and lower respiratory tracts, followed by necrotizing glomerulonephritis and systemic vasculitis [1]. Approximately 50% of patients with Wegener’s granulomatosis experience neurological manifestations at some point during the course of their disease [2–5]. The most frequent neurological involvement is peripheral neuropathy in the form of symmetrical or asymmetrical polyneuropathy, mononeuropathy multiplex or multiple cranial neuropathies. The basilar parts of the skull may be eroded, with spread of granuloma to the cranial cavity and more remote parts; the orbita are involved in 20% of patients. Wegener’s granulomatosis may also cause (though rarely) intracranial complication in the absence of nasal or renal disease and without cerebral angiographic abnormalities. Cerebral involvement in Wegener’s granulomatosis is a rare complication that can arise at any time during the course of the disease and at any place in the brain, leading to a variety of neurological symptoms. We report a case of undiagnosed Wegener’s granulomatosis presenting with subarachnoid hemorrhage and multiple intracerebral hemorrhages from preexisting granulomata after i.v. anticoagulation for myocardial infarction.