We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Churg-Strauss Syndrome An Uncommon Cause of Intracerebral Hemorrhage

Santosh B. Murthy, MD, MPH1; Natalia Khalaf, MD2; Shreyansh Shah, MD1; Brandy Ma, MD1; Corey E. Goldsmith, MD1; Joseph S. Kass, MD, JD1
[+] Author Affiliations
1Department of Neurology, Baylor College of Medicine, Houston, Texas
2Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
JAMA Neurol. 2013;70(12):1580-1581. doi:10.1001/2013.jamaneurol.414.
Text Size: A A A
Published online


A 58-year-old man with asthma, chronic sinusitis, and nasal polyposis presented with a 1-day history of headache, blurry vision, and vomiting. His blood pressure was 170/88 mm Hg. Neurological examination was significant for right homonymous hemianopsia. Initial laboratory results were remarkable for peripheral blood eosinophilia (25%; normal, 0%-8.5%). A computed tomographic scan of the head showed an intracranial hemorrhage in the left occipital lobe (Figure 1A). Emergent evacuation of the intracranial hemorrhage was performed, and brain tissue was sent for routine biopsy. On postoperative day 2, he developed cough and shortness of breath. Oxygen saturation was 90%. A general examination revealed coarse crackles bilaterally on chest auscultation. Diffuse alveolar hemorrhage was noted on a computed tomographic scan of the chest (Figure 1B). He was intubated for respiratory failure. Further workup revealed an elevated myeloperoxidase–antineutrophil cytoplasmic antibody (>1000 EU; normal, 0-21 EU). Brain tissue pathologic study results showed an intense eosinophilic vasculitis (Figure 2A and B). A diagnosis of Churg-Strauss Syndrome (CSS) was made. The patient received pulse cyclophosphamide infusion and a 5-day course of pulse intravenous methylprednisone (1000 mg/d). His respiratory parameters improved, and he was weaned off the ventilator. He was discharged and prescribed oral prednisone and monthly cyclophosphamide infusions. Brain magnetic resonance imaging (Figure 2C) obtained 6 weeks later showed a small residual left occipital hematoma, with no evidence of chronic ischemic sequelae or microhemorrhages. At the 3-month follow-up, the patient’s neurological examination showed a residual right homonymous hemianopsia. He was able to ambulate independently. His language functions were intact, with no aphasia or difficulty in reading or writing.

Figures in this Article


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Computed Tomographic Images

A, Head computed tomographic scan showing left occipital hematoma with effacement of the temporal and occipital horns of the lateral ventricle. B, Thorax computed tomographic scan showing diffuse alveolar hemorrhage.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Hematoxylin and Eosin Stainings

Hematoxylin and eosin stainings of the brain tissue showing an eosinophilic vasculitis at different magnifications (A, original magnification ×200; and B, original magnification ×400). C, Brain magnetic resonance imaging axial fluid-attenuated inversion recovery sequence at 6 weeks showing the residual left occipital intracranial hemorrhage.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Collections