Brain Pathology Case of the Month - February 2001


Small wedge-shaped renal cortical infarcts were seen in the territories of arcuate and interlobular arteries, some of which showed active vasculitis with intramural neutrophil leucocytes and fibrinoid necrosis (Fig. 2). Some arteries exhibited marked myo-intimal proliferation, suggesting a resolving vasculitis. Scattered glomeruli showed sclerosis, and fibrinous material was occasionally found within glomerular tufts (Fig. 3), but there was no evidence of crescent formation. Interstitial fibrosis indicative of chronic interstitial nephritis was interpreted as secondary to arteritis. Signs of coronary or pulmonary vasculitis were not present.

At the site of SAH, a few small arteries and venules of the leptomeninges showed transmural inflammation, which consisted of a mixed population of leucocytes, including neutrophils (Fig. 4). One vessel showed fibrinoid necrosis. Granulomatous inflammation or multinucleated giant cells were not found. There were focal ischaemic changes at several levels of the spinal cord, but no vasculitis of intraparenchymal vessels. In the cerebrum, two tiny infarcts were found in the striatum. These were accompanied by arteriosclerosis, but not by evidence of vasculitis. In the cerebellum, patchy loss of Purkinje cells was associated with Bergmann gliosis, and this pathology was maximal in the vermis.


International Society of Neuropathology