Headaches are also common. When excruciating, they often indicate SLE flare, and when milder, they are difficult to distinguish from migraine or tension headaches.4 Small mycotic, berry aneurysms are known to occur in SLE, and may present with sudden rupture-SAH. Although the incidence of SAH ranges from 15.3% to 30% in autopsied SLE patients, true incidence of cerebral aneurysm associated with SLE is unknown. Aneurysm formation in SLE is thought to be a sequel of inflammation and necrosis of tunica media.5 Subarachnoid hemorrhage in SLE secondary to rupture of these aneurysms is suspected, and proved by meticulous
Inhibitors,research,lifescience,medical clinical examination, good imaging techniques and specific autoantibodies. Subarachnoid hemorrhage renders brain critically ill from both primary and Inhibitors,research,lifescience,medical secondary brain insults. Excluding head trauma, the most common cause of SAH is rupture of aneurysms. Aneurysms in the brain can undergo rupture and subsequent leaks of blood into the subarachnoid space; the so called Integrase assay sentinel bleed.6 Herein the a case of lupus nephritis, in remission, presenting with headache is described. Case
Description A 22-year-old girl presented to the Outpatient Department (OPD) of a tertiary Inhibitors,research,lifescience,medical care hospital with complaints of headache and nausea for one week. She was a known case of SLE for the preceding three and a half years and was on a regular follow up. She had been treated earlier Inhibitors,research,lifescience,medical on two different occasions in the same institution for the relapse of nephrotic syndrome, and had achieved complete remission with 2 mg/kg mycophenolate mofetil (MMF) and 30 mg/kg prednisolone. Her renal biopsy done earlier was suggestive of focal segmental glomerulonephritis. On examination
her blood pressure (BP) was 150/90 mmHg and pulse rate (PR) was 96 beats per minute (bpm). Clinical examination did not reveal signs of raised intracranial tension or neurological deficits, and her fundoscopic examination was normal. She was admitted and thoroughly evaluated. Plain CT Inhibitors,research,lifescience,medical scan brain, lumbar puncture, echocardiography, and abdominal ultrasound with renal Doppler were normal. Antiphospholipid antibodies (APLA) values were significantly positive. The patient was treated with intravenous pulse methylprednisolone (1000 mg) therapy with and cyclophosphamide (2 mg/kg/day) for five days. Urine protein and creatinine ratio was less than 1.5. Abdominal ultrasound with renal Doppler studies was done to exclude renal vascular pathology. GBA3 The values of renal parameters helped us to make our thought clear of the possibility of any relapse of lupus nephritis. On the third day of her admission, she had severe headache. A high degree of suspicion of vascular aneurysm was kept in mind, and she underwent a four vessel angiography (figure 1), which revealed two culprit saccular aneurysms of 7.2 mm and 3.9 mm at the bifurcation of left middle cerebral artery (MCA).