Idiopathic granulomatous angiitis of the CNS manifesting as diffuse white matter disease
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To the Editor: We read with interest Dr. Finelli et al.'s report1 of a patient with idiopathic granulomatous angiitis of the CNS (IGANS) manifesting as diffuse white matter disease and wish to report a similar case whose presenting manifestation was an intracerebral hemorrhage.
This 76-year-old woman was admitted in January 1998 for evaluation of acute confusion, seizures, and somnolence. She had been well until 9 months earlier when she developed an acute left frontal intracerebral hemorrhage requiring surgical evacuation. Histopathologic study showed clusters of arachnoid-like cells, histiocytes, and a few "atypical" cells. A progressive decline in her cognitive functions ensued. Fever and an exacerbation of her confusion prompted rehospitalization …
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