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Subarachnoid hemorrhage in sickle cell anemia

Intracranial hemorrhage, frequently due to aneurysmal rupture, can occur in sickle cell anemia and requires intra-arterial angiography, with its associated risks, for diagnosis.' Magnetic resonance angiography (MRA), a noninvasive technique, demonstrates large cerebral vaso-occlusive disease in sickle cell anemia.* We report the imaging by MRA of a cerebral aneurysm in a young woman with sickle hemoglobinopathy and subarachnoid hemorrhage. Case report. A 22-year-old woman with sickle cell anemia had received blood transfusions over 5 years for the treatment of vasoocclusive complications that, for the 15 months before admission, maintained the hematocrit nadir between 25% and 35% and sickle hemoglobin (Hb S) values below 35% (except when levels twice rose to 50%). One day prior to admission, she developed severe frontal headache, photophobia, nuchal rigidity, and vomiting. On admission, she was alert but irritable, febrile, with photophobia and severe headache. Physical examination found nuchal rigidity, a positive Kernig's sign, and no other neurologic abnormalities. CSF was nonxanthochromic with 100,OOO red blood cells/mm3, 144 white blood cells/mm3, protein level of 140 mg/dl, and glucose = 62 mg/dl. CT showed no intracranial hemorrhage. She was admitted to Rainbow Babies and Childrens Hospital and treated symptomatically. Lumbar puncture on the following day had 67,000 red blood cells/mm3,68 white blood cells/mm3,