Multifocal Hemorrhagic Vasculopathy: Possibly a Manifestation of Central Nervous System Vasculitis

We report a patient with multiple spontaneous intracerebral hemorrhages involving cortical, subcortical, and deep brain structures. Despite extensive evaluation, no etiology was identified, and the possibility of primary central nervous system (CNS) vasculitis was entertained. Brain biopsy revealed small vessels with a lymphocytic infiltrate in brain tissue adjacent to hemorrhage. Despite this nonspecific finding, the patient appeared to respond to immunosuppressive therapy. In this report we review the various presentations of CNS vasculitis and suggest that this diagnosis be considered in the setting of multiple spontaneous intracerebral hemorrhages.