Abstract
We report 2 cases of systemic lupus erythematosus (SLE) with anti-phospholipid antibodies (aPLAb) presenting with cerebral hemorrhage after ischemic stroke. Case 1 was a 42-year-old man who had suffered from SLE 3 years previously, and was admitted to our hospital because of cerebral infarction. Thalamic hemorrhage occurred while he was hospitalized. Case 2 was a 37-year-old woman who had suffered from SLE 9 years previously, had 2 ischemic strokes prior to admission, and was admitted because of ischemic stroke. Thalamic hemorrhage with ventricular rupture occurred 1 year after the last ischemic stroke and she died. Both cases exhibited severe hypertension during their course. In case 2, a postmortem examination of the central nervous system was performed. Multiple large infarcts and massive cerebral hemorrhage were observed. Microscopic examinations revealed arteriolar thickening, small infarcts and hemorrhages, but angitits and angionecrosis were not detected. These findings differed from those in hypertensive cerebral hemorrhage. Although aPLAb may play an important role in the development of ischemic stroke in SLE, cerebral hemorrhage is a rare complication. We speculate that severe and uncontrolled hypertension is an important risk factor of cerebral hemorrhage in SLE patients with aPLAb.
