Abstract
A 52-year-old woman with clinical manifestations of Winiwarter-Buerger's disease (thromboangiitis obliterans : TAO) developed an intracerebral hemorrhage. She had been suffering from gangrene of her fingers and toes for 13 years and had been receiving ticlopidine for the last three years. She was admitted to our hospital after a sudden onset of convulsive seizure and consciousness disturbance. CT scanning showed a walnut-sized high density area in the left frontal opercula. The left carotid angiography demonstrated tapering of posterior internal frontal artery as well as wide-spread narrowing of operculofrontal artery. Based on these angiographical findings and the patient's history of Winiwarter-Buerger's disease, a diagnosis of cerebral thromboangiitis obliterans (CTAO) was made. Our speculation is that the long term use of ticlopidine might have induced the intracerebral hemorrhage in this CTAO patient with possibly fragile cerebral vessels. The occurrance of intracerebral hemorrhage in this patient appears to claim precautious monitoring in high-dose antiplatelet therapy for patients with Winiwarter-Buerger's disease, especially for those with concomittant CTAO.
