We report a 57-year-old woman with optic-spinal form of active
multiple sclerosis, who developed a large lobar type
hemorrhage of the brain. She initially suffered from left visual loss, and three month later, she was hospitalized with
paraplegia and total sensory loss up to the fourth thoracic level accompanied by sphincteric disturbance. Diagnosis of clinically probable
multiple sclerosis was based on the relapsing-remitting
clinical course and laboratory findings. Five months after admission, she developed sudden consciousness loss. Brain CT scan showed a massive
hemorrhage in the right frontal to parietal lobe. The patient had no risk factors for
cerebral hemorrhage including
hypertension. Histopathological study of brain tissues obtained at surgical evacuation of
hematoma did not reveal any
malignancy, and
congo-red staining of this specimen was negative. We analyzed coagulation, fibrinolytic, and endothelial parameters during the follow-up period.
von Willebrand factor (vWF) as a marker for endothelial damages was elevated persistently. Moreover,
thrombin-antithrombin III complex (TAT) as a marker for activation of coagulation was also elevated constantly throughout the
clinical course. The findings suggest that fragility of the vascular walls and permeability changes associated with immunological mechanisms might have resulted in the
cerebral hemorrhage. Although there are few reports of
cerebral hemorrhage in patients with
multiple sclerosis, it has been reported that vascular wall damage is an important aspect of the pathology of
multiple sclerosis and acute cerebral vascular damage may sometimes occur in
multiple sclerosis. We propose that coagulation studies including the endothelial marker such
as vWF would provide a useful information regarding the risk of cerebrovascular complication in
multiple sclerosis.