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Case Reports
. 2025 Feb 8;2025(2):rjaf033.
doi: 10.1093/jscr/rjaf033. eCollection 2025 Feb.

A rare case of unexplained recurrent intracerebral haemorrhage

Bo B Cao  1 , Jinlong J Wang  2 , Qinguang Q Ren  3
Affiliations
Case Reports

A rare case of unexplained recurrent intracerebral haemorrhage

Bo B Cao et al. J Surg Case Rep. .

Abstract

Recurrent intracerebral haemorrhage (ICH) presents a complex clinical challenge that eludes traditional diagnostic and treatment approaches. We report a rare and unexplained case of a middle-aged patient with recurrent ICH, for which extensive multidisciplinary investigations have yet to provide a definitive diagnosis or an effective long-term treatment strategy. Intraoperative pathology, genetic testing, cerebral angiography, inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), specific antibodies (ANCA, anti-nuclear antibodies), and immunoglobulin levels showed no specific positive findings. This case highlights the limitations of current diagnostic and therapeutic modalities in recurrent ICH. Further research into the genetic and molecular underpinnings of recurrent ICH is needed to enhance diagnostic accuracy and develop targeted therapies for similar cases.

Keywords: case reports; cerebrovascular disease; neurosurgical interventions; rare cerebrovascular cases; recurrent intracerebral haemorrhage.

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Conflict of interest statement

The authors declare no conflict of interest exits in the submission of this manuscript, and manuscript is approved by all authors for publication. I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously, and not under consideration for publication elsewhere, in whole or in part. All the authors listed have approved the manuscript that is enclosed.

Figures

Figure 1
Figure 1
Intraoperative pathological images. Microscopic image showing a portion of the brain tissue with haemorrhagic areas. The vascular morphology in the lesion is irregular, with an indistinct hierarchical vascular wall structure and multiple lumen sizes.
Figure 2
Figure 2
Angiography of the brain. Brain angiography showing obvious vascular malformations.
Figure 3
Figure 3
Brain CT scan showing multiple previous haemorrhagic lesions in the brain parenchyma with evidence of chronicity.
Figure 4
Figure 4
Brain MRI showing dynamic haemorrhage. (a) T2-weighted MR image showing multiple CCMs. The highlighted portions indicate areas of hemosiderin deposition associated with previous haemorrhages. (b) post-contrast T1-weighted MR images showing the enhancement patterns of CCMs and the extent of the surrounding oedema.
Figure 5
Figure 5
SWI images of the brain. Brain angiography showing obvious vascular malformations. SWI images of the brain showing multiple haemorrhagic lesions with some active bleeding.
See this image and copyright information in PMC

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