Haemorrhagic complications of multiple sclerosis

SUMMARY Neurological exacerbations in multiple sclerosis patients are usually attributed to relapses of the disease. This report emphasises that other conditions, such as spontaneous CNS haemorrhage, may be responsible for the clinical deterioration. We describe two patients appro-priately diagnosed as having multiple scleiosis who developed spontaneous CNS haemorrhage. When a clinical diagnosis of multiple sclerosis is made, subsequent neurological events are usually attributed to relapses of the disease. However, other conditions may occur in patients with multiple sclerosis or may simulate that disease. ' There have been reports of primary brain tumours2 and other neurological conditions occurring in patients with multiple sclerosis. Occasionally there is a problem of differentiating it from the collagen-vascular disorders.`' Two patients appropriately diagnosed as having multiple sclerosis who subsequently developed spontaneous CNS haemorrhage are described. The objectives of this report is to emphasise the importance of careful evaluation of each ex-acerbation of the clinical state of a multiple sclerosis,patient, and to illustrate that aetiological possibilities, other than relapse, must be included in the differential diagnosis of clinical exacer-bation. The possible mechanisms of haemorrhages in patients with multiple sclerosis will be dis-cussed. Case reports CASE 1 This 31-year-old woman, previously diagnosed as having multiple sclerosis, was recently admitted to the Neurosensory Center of Houston with a four-day history of headache, confusional state, and right-sided weakness involving face, arm, an